CONSUMER RESEARCH ON FRONT OF PACKAGE NUTRITION LABELING

Submitted to
Health Canada

Prepared by
Leger

Ce rapport est aussi disponible en français.
Contract number HT372-173890/001/CY
POR #073-17
Awarded 2018-01-05

Project 14224-004
2018-10-18

Leger
507 Place d'Armes, Suite 700
Montréal, Québec
H2Y 2W8
Phone: 514-982-2464
Fax: 514-987-196

Table of Content

• Table of Content
• Executive Summary
  • 1.1 Background
  • 1.2 Research Objectives
  • 1.3 Design
  • 1.4 Key Findings
  • 1.5 Conclusion
  • 1.6 Note for Reading the Report
  • 1.7 Notes on Research Findings
  • 1.8 Political Neutrality Statement and Contact Information
• 2. Detailed Results
  • 2.1 Initial Awareness, Understanding, and Use of FOP nutrition symbols
  • 2.2 Importance of the Health Canada Attribution
  • 2.3 Regulatory Specifications for FOP Nutrition Symbols
    • 2.3.1 FOP Nutrition Symbol Size
    • 2.3.1.1 Awareness Task
    • 2.3.1.2 Understanding Task
    • 2.3.2 FOP Nutrition Symbol Location
    • 2.3.2.1 Awareness Task
    • 2.3.2.2 Understanding Task
  • 2.4 Restriction of Other Nutrition Information Near the FOP Nutrition Symbol
    • 2.4.1 Consumer Understanding
    • 2.4.2 Consumer Appraisal and Use
    • 2.4.2.1 Non-specific Task
    • 2.4.2.2 Specific Task
  • 2.5 Additional Comments Regarding Consumers Access, Understanding, Appraisal, and Use of the FOP Nutrition Symbol
  • 2.6 Conclusion
• Appendix A - Detailed Research Methodology
  • A.1 Methods
  • A.2 Data Collection
  • A.3 Sampling Procedure
  • A.4 Participation Rate for the Mock Package Trial
  • A.5 Non-Response Bias and Additional Socio-Demographic Analysis
  • A.6 Participant Profiles
  • A.6.1 Health Literacy Status
  • A.6.2 Presence of Health Problems
  • A.6.3 Food Habits and Label Reading
  • A.7 Research Protocol
• Appendix B - Survey Questionnaire
• Appendix C - Mock-Ups Examples
• Appendix D - Helpfulness of information used to choose products in non-specific and specific tasks
  • D.1 Non-specific Task (Beverages)
  • D.2 Specific Task (Crackers)

Prepared for HEALTH CANADA
Supplier Name: Léger
October 2018

This public opinion research report presents the results of an online consumer research conducted by Léger on behalf of Health Canada. The research was conducted with Canadians consumers in March 2018.

Ce rapport est aussi disponible en français sous le titre : RECHERCHE AUPRÈS DES CONSOMMATEURS SUR L'ÉTIQUETAGE NUTRITIONNEL SUR LE DEVANT DES EMBALLAGES 2018.

This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact Health Canada at por-rop@hc-sc.gc.ca.

^©Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2018.

Executive Summary

1.1 Background

One of the key goals under Health Canada's Healthy Eating Strategy is to improve food labelling to help make it easier for Canadians to make healthier food choices at the grocery store. To help achieve this, Health Canada has introduced proposed regulations for front-of-package (FOP) nutrition labelling to provide quick and easy guidance to help Canadians make informed food choices to reduce intakes of foods high in sodium, sugars and/or saturated fat.

1.2 Research Objectives

Health Canada commissioned Leger (Montreal, QC) to conduct online consumer research designed to simulate a food shopping experience. The objectives were: (1) to evaluate whether the proposed FOP labelling can help Canadians, especially vulnerable Canadians at risk of marginal health literacy (HL), quickly and easily identify foods high in sodium, sugars and/or saturated fat; and (2) to inform Health Canada's proposed FOP labelling regulatory specifications (e.g., FOP nutrition symbol size, location, Health Canada attribution, and restrictions to other nutrition information that will best facilitate consumer awareness, understanding, appraisal and use of the FOP nutrition symbol).

1.3 Design

A total of 4,049 adult participants of varying HL levels (59% marginal HL; 41% adequate HL) were recruited from Leger's Online Panel throughout March 2018. Participants were diverse in gender, age, geography across Canada, and language. Three quarters (74%) were responsible for all or most of their household grocery shopping and the vast majority of participants (90%) reported using nutrition labels on food packages to make some of their food choices.

Participants were first randomized into one of two arms - with or without Health Canada attribution included in the design of the FOP nutrition symbol. Within each arm, participants were further randomized into one of four FOP nutrition symbol groups, and then further randomized into proposed regulatory labelling specifications or alternate labelling subgroups. Those in the proposed specifications group saw food packages with the FOP nutrition symbol in the proposed size or proposed location (top 25% or right 25% of package) or proposed placement of nutrition claims (away from the FOP nutrition symbol). Participants in the alternate group saw food packages with the FOP nutrition symbol in a smaller size or alternate location (bottom 65% of package or inconsistent locations across packages) or with nutrition claims beside the FOP nutrition symbol. Given that the objectives of this research were to inform regulatory requirements related to the FOP nutrition symbol design and its ability to enable consumers to quickly and easily identify foods high in sugars, sodium and/or saturated fat, participants only saw the front of the package of the foods.

Participants completed a range of timed food tasks designed to measure awareness and understanding of the FOP nutrition symbols in different motivational scenarios. For example, participants were asked to find the FOP nutrition symbol on different food packages, identify the nutrients the food is high in, and distinguish products high in specific nutrients from others. General (non-specific) and nutrient-specific shopping tasks explored the use of the FOP nutrition symbol relative to other front of package label information in making food choices. Multiple choice questions were used to examine participants' awareness, understanding, appraisal and use of the FOP nutrition symbol when making their food choices.

Successful choices and the time to make the choices were analyzed quantitatively. Pooling of the results from the 4 symbol design arms was conducted and results were compared across proposed and alternate labelling subgroups to assess differences due to FOP nutrition symbol size, location, Health Canada attribution, and proximity of claims.

1.4 Key Findings

The FOP nutrition symbol is a helpful consumer tool (Objective 1)
Upon exposure to the FOP nutrition symbols on foods participants were more likely to choose a food without a FOP nutrition symbol. Almost all participants stated that the FOP nutrition symbol helped them to easily see which foods were high in sodium, sugars and/or saturated fat. Perceptions about foods carrying a FOP nutrition symbol included food behaviours such as limiting how much and how frequently these foods should be eaten.

A Health Canada attribution increases trust and credibility (Objective 2)
The presence of the Health Canada attribution resulted in higher trust and credibility for the FOP nutrition symbol.
Size and location of the FOP nutrition symbol is important (Objective 2)
While most participants noticed the FOP nutrition symbol regardless of its size or location, significantly more participants understood it faster when its size was larger and it was in the proposed location. While participants with adequate HL performed better and faster at noticing and understanding the FOP nutrition symbol, most participants at risk of marginal HL also noticed and understood the FOP nutrition symbol.

Proximity of other nutrition information had little impact on the use of FOP nutrition symbols (Objective 2)
Overall, the proximity of other nutrition information to the FOP nutrition symbol had little impact on the time or success in making food choices from amongst a variety of options. However, participants used other nutrition information, such as the "no added sugars" claim and Food Stars rating, more frequently than the FOP nutrition symbol when choosing from among beverages with a high in sugars FOP nutrition symbol. Marginal HL participants consistently relied on the FOP nutrition symbol more frequently than adequate HL consumers when making beverage choices. However, when participants made unsuccessful food choices, participants tended to rely on other nutrition information on the front of the package.

1.5 Conclusion

The proposed labelling approach, including format requirements related to size, location, and Health Canada attribution, was shown to be effective in providing participants of varying HL levels with quick and easy guidance on foods that are high in sugars, sodium and/or saturated fat. The proximity of other nutrition information had little effect on consumers' understanding and use of the FOP nutrition symbol. However, the presence of other nutrition information can impact the use of the FOP nutrition symbol, such that it may not be the primary source of information on the front of the package used when making a food choice.

1.6 Note for Reading the Report

In this report, results are presented in the form of crosstabs. The "total" column presents the results for the whole sample. Then, results for sub-groups of the sample are presented at the right of the "total" column. The total column represents the results for the overall sample.

1.7 Notes on Research Findings

The views and observations expressed in this document do not reflect those of Heath Canada. This report was compiled by Leger based on the research conducted specifically for this project. The findings cannot be inferred to the general population of Canada.

1.8 Political Neutrality Statement and Contact Information

This report was prepared by Leger who was contracted by Health Canada (contract number HT372-173890/001/CY awarded January 5, 2018).

I hereby certify as Senior Officer of Leger that the deliverables fully comply with the Government of Canada's political neutrality requirements outlined in the Directive on the Management of Communications.

Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, standings with the electorate, or ratings of the performance of a political party or its leaders.

Christian Bourque
Executive Vice-President and Associate
Leger
cbourque@leger360.com
514-982-2464

Additional information

The expenditure for this project is $89,722.00 (including HST).

Detailed Results

A total of 4,049 adult participants of varying HL levels (59% marginal HL; 41% adequate HL) were recruited from Leger's Online Panel throughout March 2018. Participants were diverse in gender, age, geography across Canada, and language. Participant demographics, including HL status, health status, food habits, and use of nutrition labelling are detailed in Appendix A.

2.1 Initial Awareness, Understanding, and Use of FOP nutrition symbols

2.1.1 Initial awareness of FOP nutrition symbols

The objective of this introductory task was to ensure that all participants were made aware of the presence of a FOP nutrition symbol on foods high in nutrients of public health concern. This task asked each participant to choose a cereal for their household. Participants were exposed to cereal packages with FOP nutrition labelling based on their randomly assigned FOP nutrition symbol.

Some cereal choices were high in sodium, sugars and/or saturated fats and had a FOP nutrition symbol on them. Only one, the Synergy Flakes, did not carry a FOP nutrition symbol. The cereal choices included Honey Swirls (high in sugars), Multigrain Cereal (high in sodium), Granola Crunch (high in sugars, sodium and sat fat), and Synergy Flakes (not high in sugars, sodium and sat fat) (Figure 1 and Appendix A, Table A8).

Figure 1. Examples of cereals

Note that participants saw only those food packages with their randomly assigned FOP nutrition symbol.

Participants who did not initially notice the FOP nutrition symbol on any of the cereal packages were shown the FOP nutrition symbol and asked if they would like to choose another cereal or keep their first choice.

Just less than half (46%) of participants initially noticed the FOP nutrition symbols on the cereal packages (Figure 2). More participants with adequate HL (50%) noticed the FOP nutrition symbols than those with marginal HL (43%).

Figure 2. Initial awareness of the FOP nutrition symbol on foods (n=4,049)

Results of questions 12 and 26 - Did you notice these nutrition symbols on any of the cereals?

2.1.2 Initial understanding of FOP nutrition symbols

Almost half (47%) of participants who initially noticed the FOP nutrition symbol chose Synergy Flakes, the only cereal without a FOP nutrition symbol (Figure 3). Among those who did not initially notice the FOP nutrition symbol only 17% chose Synergy Flakes (Figure 4). However, after being shown the FOP nutrition symbol, almost two-third of these participants (62%) chose Synergy Flakes.

Figure 3. Cereal choice among participants who initially noticed FOP nutrition symbol (n=4,049)

Results of questions 11 and 25 - Choose a cereal for your household.

Figure 4. Cereal choice among participants who did not initially notice FOP nutrition symbol (n=4,049)

Results of questions 16 and 30 - Now that you have seen the nutrition symbol, which cereal would you choose for your household?

Main reasons participants changed their cereal choice to Synergy Flakes were: don't want a cereal that is high in sugars (25%), sodium (20%) or saturated fat (13%) or wanting a healthier choice (19%). Main reasons to maintain their cereal choice of Synergy Flakes included: it is the healthiest choice (17%), which is low in sugars (20%), sodium (7%) or saturated fat (6%) and it does not have a FOP nutrition symbol (13%). For those participants who maintained their initial choice of one of the cereals with a FOP nutrition symbol, their main reason was that they liked the chosen cereal, including its perceived taste (35%).

2.1.3 Initial utility of FOP nutrition symbols for making food choices

Almost all participants who initially noticed the FOP nutrition symbol (94%) mentioned it was helpful when they made their cereal choice (Figure 5). More than half (53%) said it made them consider if they wanted to choose a cereal with a FOP nutrition symbol. Many mentioned that the FOP nutrition symbol made it easy to see which cereal was high in sugars (51%), sodium (45%) or saturated fat (43%). Finally, two out of ten (22%) said it confirmed what they knew about cereal.

Figure 5. Utility of FOP nutrition symbols for making food choices
(Participants who initially saw the FOP nutrition symbol: n=1,854)

Results of Question 13 and 27 - How did the nutrition symbol help you make your cereal choice? MULTIPLE ANSWERS ALLOWED* Because participants were allowed to give several answers, total mentions may be higher than 100%.

Less than 2% (n=67) of participants considered a FOP nutrition symbol as not helpful when making food choices. Some reasons included: taste is more important (22%), a lack of trust in nutrition information on the front of food packages(12%), the FOP nutrition symbol repeats information they already know (i.e., that the cereal is high in sugars 7%, sodium 6% or saturated fat 6%) (Figure 6).

Figure 6. Lack of utility of FOP nutrition symbols for making food choices (n=67)

Results of questions 14 and 28 - Why the FOP nutrition symbol was NOT helpful when making food choices?

2.1.4 Initial perceptions of FOP nutrition symbols

Four out of ten participants thought that a food with a FOP nutrition symbol had a lot of sugars, saturated fat, and/or sodium (Figure 7). Almost two out of ten (19%) also thought a food with a FOP nutrition symbol was an unhealthy choice, whereas 11% thought it was a treat. It should also be noted that two out of ten participants (18%) did not understand the meaning of the FOP nutrition symbol at all, thinking that a food with a FOP nutrition symbol was a healthy choice. A greater proportion of participants with marginal HL thought that a food with a FOP nutrition symbol was a healthy choice (24%). Few participants (7%) felt that a food with a FOP nutrition symbol should not be eaten, while others felt that foods with FOP nutrition symbols should be eaten in limited portion sizes (35%) or eaten less often (30%).

Figure 7. Perceptions of FOP nutrition symbols on foods (n=4,049)

Results of Question 15, 19, 29 and 33 - Which of the following statements describes what the nutrition symbol means to you? MULTIPLE ANSWERS ALLOWED*Because participants were allowed to give several answers, total mentions may be higher than 100%.

2.2 Importance of the Health Canada Attribution

Figure 8. Example of FOP nutrition symbol with Health Canada attribution

*Note that participants saw only their randomly assigned FOP nutrition symbol.

Almost all participants who saw the FOP nutrition symbol with the Health Canada attribution (91%) found it helpful to include the attribution to Health Canada as part of the FOP nutrition symbol (Figures 8 and 9). On a scale of 1 (not at all helpful) up to 7 (very helpful) about two-thirds of participants (67%) ranked the usefulness of the Health Canada attribution as 6 or 7.

Figure 9. Helpfulness of the Health Canada attribution
(Participants who saw the FOP nutrition symbol with the Health Canada attribution: n=2,025)

Results of Question 20 - How helpful is it to have "Health Canada" as part of the nutrition symbol?

Among participants who thought it was helpful to have the words "Health Canada" as part of the FOP nutrition symbol, 44% said it is because it tells them who is responsible for the FOP nutrition symbol and 46% said that it makes them trust the FOP nutrition symbol (Figure 10). Also, 36% said that it draws their attention to the FOP nutrition symbol and 30% said the attribution makes the FOP nutrition symbol look more official.

Figure 10. Reasons participants felt the Health Canada attribution was helpful
(Participants who thought it was helpful to have Health Canada as part of the FOP nutrition symbol: n=1,835)

Results of Question 22 - Why is it helpful to have the words 'Health Canada' as part of the nutrition symbol? MULTIPLE ANSWERS ALLOWED* *Because participants were allowed to give several answers, total mentions may be higher than 100%.

Less than 1 in 10 participants (8.5%) thought the attribution to Health Canada in the FOP nutrition symbol was not helpful. Almost one out of four (39%) of these participants said it was obvious to them that the FOP nutrition symbol must come from Health Canada / the Government (Figure 11). About a quarter of them (28%) did not know what the attribution to Health Canada in a FOP nutrition symbol meant. A few mentioned other reasons such as a lack of trust/credibility (8%) of the attribution.

Figure 11. Reasons participants felt the Health Canada attribution was not helpful
(Participants who thought it was not helpful to have Health Canada as part of the FOP nutrition symbol: n=173)

Results of Question 21 - Why is it not helpful to have Health Canada as part of the FOP nutrition symbol?

Half of participants who saw the attributed symbol mentioned that the words "Health Canada" meant that Health Canada has determined that the food is high in sodium, sugars and/or saturated fat (51%) or tested the nutrient content of the food (47%). Less than a third thought it meant Health Canada put this nutrition symbol on the food (29%). Some believed that Health Canada considers a food with a FOP nutrition symbol on it an unhealthy food (14%). A minority thought it meant Health Canada recommends this food (11%) while 6% said that Health Canada doesn't mean anything to them (Figure 12).

Figure 12. Understanding of the Health Canada attribution in the FOP nutrition symbol
(Participants who saw the FOP nutrition symbol with the Health Canada attribution: n=2,025)

Results of Question 23 - What does 'Health Canada' in the nutrition symbol mean to you? MULTIPLE ANSWERS ALLOWED* *Because participants were allowed to give several answers, total mentions may be higher than 100%.

A greater percentage of participants who saw the FOP nutrition symbol with the Health Canada (HC) attribution said they would trust the FOP nutrition symbol on foods (4 to 7) compared to those who saw the FOP nutrition symbol without the attribution (93% vs. 86%) (Figure 13). High levels of trust (6 and 7) in the FOP nutrition symbol were expressed by 63% of participants seeing the FOP nutrition symbol with the Health Canada attribution and 45% seeing the FOP nutrition symbol without the Health Canada attribution.

Figure 13. Trust in the FOP nutrition symbol on foods (%)
(Participants who saw the FOP nutrition symbol with the Health Canada attribution: n=2,025; or without the Health Canada attribution: n=2,024)

Results of questions 24 and 35 - How much would you trust this nutrition symbol on foods?

About four out of ten participants who saw the FOP nutrition symbol without the Health Canada attribution (42%) thought that the Government of Canada was responsible for this FOP nutrition symbol on foods that are high in sodium, sugars and/or saturated fat (Figure 14). More than a third of participants (35%) thought that the FOP nutrition symbol was a food industry or manufacturer initiative while 9% attributed it to health professionals.

Figure 14. Perception of who is responsible for the FOP nutrition symbol
(Participants who saw the FOP nutrition symbol without the Health Canada attribution: n=2,024)

Results of Question 34 - Who do you think is responsible for this nutrition symbol on foods that are high in saturated fat, sodium, and/or sugar?

2.3 Regulatory Specifications for FOP Nutrition Symbols

In this next section, participants were asked to complete tasks with different food products one at a time on the screen. The objectives of this module were to examine the impact of:

1. The size of the FOP nutrition symbol on consumers' ability to notice and understand the FOP nutrition symbol
2. The location of the FOP nutrition symbol on consumers' ability to notice and understand the FOP nutrition symbol
3. The restriction of other front of package information around the FOP nutrition symbol on consumers' ability to notice and understand the FOP nutrition symbol

2.3.1 FOP Nutrition Symbol Size

2.3.1.1 Awareness Task

Participants were randomized to see one of three crackers (Appendix A, Table A8). Participants in the proposed group were shown the front of the package of a cracker with a FOP nutrition symbol of the proposed size (Figure 15a). Participants in the alternate group saw the same crackers but with a smaller FOP nutrition symbol (Figure 15b). The placement and restriction of other food product information around the FOP nutrition symbol were consistent across groups and followed the proposed regulatory specifications.

Figure 15. Examples of cracker packages (proposed and alternate FOP size)

1. Proposed FOP size
2. Alternate FOP size

*Note that participants saw only those food packages with their randomly assigned FOP nutrition symbol.

The vast majority of participants (87%) were able to find the FOP nutrition symbol on the cracker they saw, regardless of the size of the FOP nutrition symbol (Gellar's 85%; Mill Bites 88%; Specter & Sons 88%) (Figure 16).

Figure 16. Overall awareness of the FOP nutrition symbol (proposed and alternate size) (n=4,049)

Results of Question 36 - Click on the nutrition symbol on this food product.

A significantly greater proportion of participants with adequate HL (98%) than those with marginal HL (80%) noticed the FOP nutrition symbol for this task (Table 1).

Table 1. Overall awareness of the FOP nutrition symbol - by HL
(n=4,049)

Results of Question 36- Click on the nutrition symbol on this food product.

Participants took 20.55 seconds to notice the FOP nutrition symbol. Participants with marginal HL needed significantly more time (3.04 seconds more) to accomplish this task then those with adequate HL (Table 2).

Table 2. Time to notice the FOP nutrition symbol - by HL (in seconds)
(Participants who noticed the symbol: n=3,535)

Results of Question 36- Click on the nutrition symbol on this food product. *The time statistic (mean calculation) is based on the participants who correctly answered the question and finished the task within 180 seconds.

The FOP nutrition symbol was noticed equally well by participants of varying HL levels in the proposed and alternate (smaller size) groups (Table 3).The FOP nutrition symbol of the proposed size was noticed 1.35 seconds slower than the smaller version by participants of varying HL status (Table 4). There was no significant interaction between HL status and the size of the FOP nutrition symbol. The proposed size of the FOP nutrition symbol takes more time for participants to notice regardless of their HL status.

Table 3. Awareness of the FOP nutrition symbol - by size (n=4,049)

Results of Question 36 - Click on the nutrition symbol on this food product.

Table 4. Time to successfully notice the FOP nutrition symbol - by size (in seconds)
(Participants who noticed the symbol: n=3,535)

Results of Question 36 - Click on the nutrition symbol on this food product. *The time statistic (mean calculation) is based on the participants who correctly answered the question within 180 seconds.

2.3.1.2 Understanding Task

Participants were randomized to see one of the three popcorns, each with a different "high in" nutrient profile. One of the popcorn packages, the Ordinary Corn, had a FOP nutrition symbol that was "high in" only one nutrient of public health concern, whereas the other two were high in two nutrients (See Appendix A, Table A8). Participants saw their randomly assigned FOP nutrition symbol in either the proposed or alternate (smaller) size on the mock package (Figure 17). They were asked to identify what nutrient(s) the popcorn was high in.

Figure 17. Examples of popcorn packages (proposed and alternate FOP size)

1. Proposed FOP size
2. Alternate FOP size

*Note that participants saw only those food packages with their randomly assigned FOP nutrition symbol.

About nine out of ten (88%) participants correctly identified that Ordinary Pop was high in sodium (Figure 18). This popcorn had only one high in nutrient on the FOP nutrition symbol. About six out of ten participants correctly identified the two high in nutrients in Caramel Corn (62%) and Cinema Popcorn (57%).

Figure 18. Overall understanding of the FOP nutrition symbol (n=4,049)

Results of Question 37 - What nutrient(s) is this product 'high in'?

Understanding of the FOP nutrition symbol was moderated by participant's HL level. Those participants with adequate HL were significantly more successful (Table 5) and faster (Table 6) at identifying what nutrient(s) the food was high in than those with marginal HL, regardless of the symbol size. Nevertheless, most participants with marginal HL (59%) understood the FOP nutrition symbol (Table 5).

Table 5. Understanding of the FOP nutrition symbol - by HL (n=4,049)

Results of Question 37 - What nutrient(s) is this product 'high in'?

Table 6. Time to understand the FOP nutrition symbol - by HL (in seconds)
(Participants who answered correctly: n=2,787)

Results of Question 37 - What nutrient(s) is this product 'high in'? *The time statistic (mean calculation) is based on the participants who correctly answered the question and finished the task within 180 seconds.

A larger proportion of participants who saw the proposed size of FOP nutrition symbol on the popcorn successfully identified the high in nutrients and took significantly less time (6.7 seconds less) than those who saw the popcorn with smaller sized FOP nutrition symbol (Tables 7 and 8).

Table 7. Understanding the FOP nutrition symbol - by size (n=4,049)

Results of Question 37 - What nutrient(s) is this product 'high in'?

Table 8. Time to understand the FOP nutrition symbol - by size (in seconds)
(Participants who answered correctly: n=2,787)

Results of Question 37 - What nutrient(s) is this product 'high in'? *The time statistic (mean calculation) is based on the participants who correctly answered the question and finished the task within 180 seconds.

2.3.2 FOP Nutrition Symbol Location

2.3.2.1 Awareness Task

For this section participants in the proposed group saw food products with FOP nutrition symbols consistently in the top right corner of the package whereas those in the alternate group saw the same products with the FOP nutrition symbol in various locations on the package. The FOP nutrition symbol size and the restriction of other information around the FOP nutrition symbol were constant across groups and followed the proposed regulatory specifications.

Participants were randomized to see one of the three brands of yogurt, each of them having different "high in" nutrients. Yogo was high in saturated fat, Indulgence was high in saturated fat and sugars, while Marino's was high in sugars (Appendix A, Table A8). Participants saw their randomly assigned FOP nutrition symbol in either the proposed or alternate location (Figure 19) on the FOP.

Figure 19. Examples of yogurt packages (proposed and alternate FOP location)

1. Proposed FOP location
2. Alternate FOP location

*Note that participants saw only those food packages with their randomly assigned FOP nutrition symbol.

When asked to locate and click on the FOP nutrition symbol on a yogurt container, the majority of participants were successful (91%), regardless of the location of the FOP nutrition symbol on the packages (Indulgence 93%; Marino's 91%; Yogo 88%) (Figure 20).

Figure 20. Overall awareness of the FOP nutrition symbol (n=4,049)

Results of Question 38 - Click on the nutrition symbol on this food product.

Virtually all participants with adequate HL (99%) noticed the FOP nutrition symbol. In comparison, a significantly smaller, but still high proportion (85%) of participants at risk of marginal HL noticed the FOP nutrition symbol (Table 9).

Table 9. Awareness of the FOP nutrition symbol on foods - by HL (n=4,049)

Results of Question 38 - Click on the nutrition symbol on this food product.

As shown in Table 10, participants took an average of 14.49 seconds to find and click on the FOP nutrition symbol. Those participants with adequate HL took significantly less time (1.95 seconds quicker) to accomplish this task than those with marginal HL.

Table 10. Time to successfully notice the FOP nutrition symbol - by HL (in seconds) (Participants who noticed the symbol: n=3,678)

Results of Question 38 - Click on the nutrition symbol on this food product. *The time statistic (mean calculation) is based on the participants who correctly answered the question within 180 seconds.

The location of the FOP nutrition symbol did not have any significant impact on the ability of participants to notice it on the package (Table 11).

Table 11. Awareness of the FOP nutrition symbol - by location (n=4,049)

Results of Question 38 - Click on the nutrition symbol on this food product.

There was no significant difference in the time to correctly perform the task between participants who saw the food packages with the FOP nutrition symbol in the proposed location or those who saw food packages with the FOP nutrition symbol in an alternate location (Table 12).

Table 12. Time to successfully notice the FOP nutrition symbol - by location (in seconds). (Participants who noticed the symbol: n=3,678)

Results of Question 38 - Click on the nutrition symbol on this food product. *The time statistic (mean calculation) is based on the participants who correctly answered the question and finished the task within 180 seconds.

2.3.2.2 Understanding Task

For the second task, participants were asked to identify which salad dressing was high in sugars and sodium. Each respondent saw three different salad dressings (Figure 21). Each salad dressing had a FOP nutrition symbol on the package but only one (Honey Poppyseed) was high in sugars and sodium (Appendix A, Table A8). The other two salad dressings were Ranch (high in saturated fat and sodium) and Caesar Light (high in sodium). Salad dressings were shown in a randomized order. Half of the sample saw salad dressings with the FOP nutrition symbol in the proposed location (at the top right corner) while the other half of the sample saw salad dressing with the FOP nutrition symbol in alternate locations on the packages.

Figure 21. Examples of salad dressing packages (proposed and alternate FOP location)
a) Proposed FOP location

b) Alternate FOP location

*Note that participants saw only those food packages with their randomly assigned FOP nutrition symbol.

Three-quarters of participants (75%) correctly identified the Honey Poppyseed as the dressing salad that was high in both sugars and sodium (Figure 22). The Caesar Light dressing which was high in sodium only was selected by 12% of participants. A similar proportion (13%) chose the Ranch dressing which was high in saturated fat and sodium. On average, it took about 41.59 seconds to correctly identify the salad dressing high in sugars and sodium.

Figure 22. Understanding the FOP nutrition symbol - by location
(n=4,049)

Results of Question 39 - Which product is 'high in' sugar and sodium?

Significantly more participants with adequate HL (86%) correctly identified the dressing salad as being high in sugars and sodium than those with marginal HL (68%) (Table 13).

Table 13. Understanding the FOP nutrition symbol - by HL (n=4,049)

Results of Question 39. - Which product is 'high in' sugar and sodium?

However, there was no significant difference in the time needed for marginal and adequate HL participants to correctly accomplish the task (Table 14).

Table 14. Time to understand the FOP nutrition symbol - by HL (in seconds) (Participants with correct answer: n=3,033)

Results of Question 39 - Which product is 'high in' sugar and sodium *The time statistic (mean calculation) is based on the participants who correctly answered the question and finished the task within 180 seconds.

The location of the FOP nutrition symbol on the salad dressing did not impact on participant's ability to successfully accomplish this task (Table 15). However, those participants of marginal HL were better able to successfully accomplish this task with the proposed location of the FOP nutrition symbol; there was no difference in success rate among participants with adequate HL for proposed and alternate locations (Table 16).

Table 15. Understanding the FOP nutrition symbol - by location (n=4,049)

Results of Question 39 - Which product is 'high in' sugar and sodium?

Table 16. Understanding the FOP nutrition symbol - by location and HL (n=4,049)

Results of Question 39 - Which product is 'high in' sugar and sodium?

However, there is a significant difference between these groups in terms of the time needed to accomplish the task (Table 17). Participants who saw the FOP nutrition symbol in the proposed location were able to successfully identify which brand of salad dressing was high in sugars and sodium 4.11 seconds quicker than those who saw the FOP nutrition symbol in alternate locations on the salad dressings.

Table 17. Time to understand the FOP nutrition symbol - by location (in seconds). (Participants who answered correctly (n=3,033))

Results of Question 39. - Which product is 'high in' sugar and sodium? *The time statistic (mean calculation) is based on the participants who correctly answered the question and finished the task within 180 seconds.

2.4 Restriction of Other Nutrition Information Near the FOP Nutrition Symbol

For this final section, all participants saw products with their assigned FOP nutrition symbol. However, participants were randomly assigned to view products with FOP nutrition symbols in the proposed size and location but either with other nutrition information far from (proposed) or next to (alternate) the FOP nutrition symbol.

2.4.1 Consumer Understanding

Participants were randomized to see one of three soups: Soup 1 was high in sodium, Soup 2 was high in saturated fat and sodium, while Soup 3 was high in saturated fat, sugars and sodium. Participants in the proposed group saw a canned soup with Health Canada's FOP nutrition symbol and another FOP nutrition labelling system that displays key nutrition information in the bottom right, whereas those in the alternate group saw the same product with the same Health Canada's FOP nutrition symbol but with the other symbol right beside Health Canada's FOP nutrition symbol (Figure 23). The size and location of Health Canada's FOP nutrition symbol on the packages were consistent across groups and followed the proposed regulatory specifications. Participants were asked to identify what nutrient(s) the soup was high in.

Figure 23. Examples of soup packages (proposed and alternate placement of other nutrition information)

1. Proposed FOP location
2. Alternate FOP location

*Note that participants saw only those food packages with their randomly assigned FOP nutrition symbol.

Soup 1 was high in only one of the three nutrients (sodium) and this was correctly identified by almost all participants who saw it (90%) (Figure 24). The soup 2 was high in two nutrients (saturated fat and sodium) and these were correctly identified by a lower proportion of participants (63%). Finally, three-quarters of participants who saw the soup 3 (75%) which was high in all three nutrients, correctly identified the presence of all of the three nutrients. Overall across all three soups, 76% of participants correctly identified the high in nutrient(s).

Figure 24. Understanding the FOP nutrition symbol - by proximity of other nutrition information (n=4,049)

Results of Question 40 - What nutrient(s) is this product 'high in'?

Participants with adequate HL were more successful at identifying high in nutrients in their soup (90%) than those at risk of marginal HL (67%), although that latter number was still high (Table 18).

Table 18. Understanding of the FOP nutrition symbol - by HL (n=4,049)

Results of Question 40. - What nutrient(s) is this product 'high in'?

Furthermore, HL moderated the time needed to correctly accomplish the task (Table 19). Participants with marginal HL took significantly more time (1.18 seconds longer) to successfully complete this task than those with adequate HL.

Table 19. Time to understand the FOP nutrition symbol - by HL (in seconds)
(Participants who answered correctly: n=3,081)

Results of Question 40. - What nutrient(s) is this product 'high in'? *The time statistic (mean calculation) is based on the participants who correctly answered the question and finished the task within 180 seconds.

There was no difference in ability or time for participants in the proposed or alternate group to successfully identify what nutrients the product was high in (Tables 20 and 21).

Table 20. Understanding of the FOP nutrition symbol - by proximity of other nutrition information (n=4,049)

Results of Question 40. - What nutrient(s) is this product 'high in'?

Table 21. Time to understand the FOP nutrition symbol - by proximity of other nutrition information (in seconds); (Participants who answered correctly: n=3,081)

Results of Question 40. - What nutrient(s) is this product 'high in'? *The time statistic (mean calculation) is based on the participants who correctly answered the question and finished the task within 180 seconds.

2.4.2 Consumer Appraisal and Use

Participants were given two shopping tasks: a non-specific food choice task followed by a specific food choice task.

The objectives of the shopping module are to:

1. Explore how the proximity of other nutrition information (e.g., health/nutrient content claims, other summary FOP symbol) affect consumers' appraisal and use of Health Canada's FOP nutrition symbol in making food decisions, and
   
2. Highlight any other issues regarding consumer access, understanding, appraisal, and use of the FOP nutrition symbols

2.4.2.1 Non-specific Task

For the non-specific task, participants were shown three beverages with FOP nutrition symbols and other nutrition information either far away from (proposed) or next to (alternate) the FOP nutrition symbol (Figure 25). All three beverages were high in sugars (Appendix A, Table A8). However, they contained different types of nutrition information on the front of the package. The Apple Juice displayed a Food Stars rating (to mimic other FOP labelling schemes), whereas the Berry Fusion had a "no sugars added" claim and the Tropical Twist had a ‟100% juice blend" claim.

Figure 25. Examples of fruit beverage packages (proposed and alternate proximity of other nutrition information)

a) Proposed proximity of other nutrition information

*Note that participants saw only those food packages with their randomly assigned FOP nutrition symbol.

b) Alternate proximity of other nutrition information

*Note that participants saw only those food packages with their randomly assigned FOP nutrition symbol.

Participants were asked to choose a beverage for their household. Four out of ten (41%) chose the Apple Juice and a similar proportion (38%) chose Berry Fusion. Two out of ten (21%) chose the Tropical Twist (Figure 26).

Figure 26. Fruit beverage choice for the household - by HL (n=4,049)

Results of Question 41 - Imagine the following situation: You have planned to go to the grocery store to buy a fruit beverage. Please look carefully at all the options. Which beverage would you choose?

There was no difference in fruit beverage choices between participants who saw the proposed or those who saw the alternate placement of other nutrition information on the beverage bottles (Table 22).

Table 22. Fruit beverage choice for household - by proximity of other nutrition information (n=4,049)

Results of Question 41 - Imagine the following situation: You have planned to go to the grocery store to buy a fruit beverage. Please look carefully at all the options. Which beverage would you choose?

Among participants who chose the Apple Juice, the Food Stars Rating (51%) was the main information used to make their choice (Figure 27). About a third used the FOP nutrition symbol (36%) or the brand name (34%). Other information, such as the food image (7%), the net weight (2%), the company name (2%) or the Kosher symbol (1%) were used by just a few.

FOP nutrition information was not used equally among all subgroups of participants when making their beverage choice. Participants with marginal HL relied on the Food Stars rating (44%) and the FOP nutrition symbol (43%) whereas those with adequate HL made more use of the Food Stars Rating (62%) or the brand name (42%) than the FOP nutrition symbol (27%) (Figure 27).

Among participants who chose the Apple Juice, the Food Stars Rating (51%) was the main information used to make their choice (Figure 27). About a third used the FOP nutrition symbol (36%) or the brand name (34%). Other information, such as the food image (7%), the net weight (2%), the company name (2%) or the Kosher symbol (1%) were used by just a few.

FOP nutrition information was not used equally among all subgroups of participants when making their beverage choice. Participants with marginal HL relied on the Food Stars rating (44%) and the FOP nutrition symbol (43%) whereas those with adequate HL made more use of the Food Stars Rating (62%) or the brand name (42%) than the FOP nutrition symbol (27%) (Figure 27).

Figure 27. Information used to choose Apple Juice - by HL

Results of Question 42 - Click on the information you used to make your choice?
MULTIPLE ANSWERS ALLOWED* *Because participants were allowed to give several answers, total mentions may be higher than 100%.

As shown in the table below (Table 23), there were no notable differences in information used to make food choices between those who saw the proposed or the alternate placement of other nutrition information approaches.

Table 23. Information used to choose Apple Juice - by proximity of other nutrition information (Participants who chose Apple Juice: n=1,648)

Results of Question 42 - Click on the information you used to make your choice? MULTIPLE ANSWERS ALLOWED *Because participants were able to give multiple answers, total mentions may exceed 100%.

Among participants who chose the Berry Fusion beverage, the "no sugars added" claim (69%) was the most highly used piece of FOP nutrition information (Figure 28). About a quarter of participants (27%) used the FOP nutrition symbol and 15% used the brand name. Also, 13% said they used the food image to make their choice. Other information, such as the company name (3%) and the net weight (2%) were used by a minority.

Figure 28. Information used to choose Berry Fusion (Participants who chose Berry Fusion: n=1,542)

Results of Question 42 - Click on the information you used to make your choice? MULTIPLE ANSWERS ALLOWED* Because participants were able to give multiple answers, total mentions may exceed 100%.

There were no significant differences between those who saw the proposed or the alternate placement of other nutrition information versions of the Berry Fusion package (Table 24).

Table 24. FOP information used to choose Berry Fusion - by proximity of other nutrition information (Participants who chose Berry Fusion: n=1,542)

Results of Question 42 - Click on the information you used to make your choice? MULTIPLE ANSWERS ALLOWED**Because participants were able to give multiple answers, total mentions may exceed 100%.

Half of participants who chose the Tropical Twist (56%) mentioned using the "100% Juice Blend" marketing claim to make their choice (Figure 29). Three out of ten (29%) used the flavour text and about the same proportion (28%) used the FOP nutrition symbol. The brand name (9%) and the food image (10%) were used by slightly more than one respondent out of ten.

Figure 29. Information used to choose Tropical Twist
(Participants who chose Tropical Twist: n=855)

Results of Question 42 - Click on the information you used to make your choice? MULTIPLE ANSWERS ALLOWED*Because participants were able to give multiple answers, total mentions may exceed 100%.

A larger proportion of participants with adequate HL used the "100% Juice Blend" marketing claim (71%) and the flavour text (42%) than those with marginal HL. The FOP nutrition symbol was used more frequently by participants with marginal HL (34%) than those with adequate HL (19%).

There were no differences in the information used to make food choices between participants who saw the proposed or alternate placement of other nutrition information on the package (Table 25).

Table 25. Information used to choose Tropical Twist - by proximity of other nutrition information (Participants who chose Tropical Twist: n=855)

Results of Question 42 - Click on the information you used to make your choice? MULTIPLE ANSWERS ALLOWED* *Because participants were able to give multiple answers, total mentions may exceed 100%.

When participants were asked how the FOP nutrition symbol might affect their use of their chosen beverage, many participants of varying HL levels (88%) stated it might affect their usage (Figure 30). Four out of ten participants (40%) said they might drink this beverage less often and 34% might drink a smaller serving. Also, a quarter (26%) might drink this beverage as a treat, whereas a similar proportion (24%) might mix it with water to make it less sugary. Finally, 17% might drink it with foods lower in sugar. Only one respondent out of ten (11%) stated that the FOP nutrition symbol would have no effect on how they might use the juice. Only a minority (2%) said they simply would not buy a beverage with a FOP nutrition symbol on it.

Figure 30. Impact of the FOP nutrition symbol on usage of beverage (n=4,049)

Results of Question 44 - How did the nutrition symbol affect how you might use this beverage?MULTIPLE ANSWERS ALLOWED* *Because participants were able to give multiple answers, total mentions may exceed 100%.

2.4.2.2 Specific Task

For the specific task, participants were shown a cheese product with a high in saturated fat FOP nutrition symbol as well as three cracker products with FOP nutrition symbols and other nutrition information either far away from (proposed) or next to (alternate) the FOP nutrition symbol (Figure 31).

All three crackers contained a FOP nutrition symbol with different high in nutrients (Appendix A, Table A8). They also all contained different types of nutrition information. The Mill Bites was high in sodium and displayed a "25% reduced sodium" claim. The Gellar's was high in saturated fat and had a Food Star rating and finally, the Specter & Sons was high in saturated fat and sodium and displayed a "source of fiber" claim.

Figure 31. Examples of cheese and cracker packages (proposed and alternate proximity of other nutrition information)

a) Proposed proximity of other nutrition information

b) Alternate proximity of other nutrition information

*Note that participants saw only those food packages with their randomly assigned FOP nutrition symbol.

This time, participants were asked to choose a cracker, to eat with the cheese for someone in their household who needs to cut down on their saturated fat intake. Seven out of ten (71%) chose the Mill Bites, which is the correct choice for this specific task, 18% chose Gellar's and one out of ten (11%) chose Specter & Sons (Figure 32). Adequate HL participants were significantly more successful at choosing the correct cracker (Mill Bites - 85%) than participants with marginal HL.

Figure 32. Cracker choice for the household - by HL (n=4,049)

Results of Question 45 - Imagine the following situation: someone in your household needs to cut down on their saturated fat intake. Which cracker would you choose for them to eat with this cheese?

There was no significant difference in cracker choices between participants who saw the proposed or the alternate version of the crackers package.

Table 26. Cracker choice for household - by proximity of other nutrition information (n=4,049)

Results of Question 45 - Imagine the following situation: someone in your household needs to cut down on their saturated fat intake. Which cracker would you choose for them to eat with this cheese?

The FOP nutrition symbol was used by three quarters of participants (73%) who chose the Mill Bites crackers (Figure 33). Also, 44% used the "25% Reduced Sodium" claim. The FOP nutrition symbol was more popular as a choice criterion among participants with adequate HL (82%). The brand name (9%) and the food image (5%) were used significantly more as a choice factor by participants with marginal HL.

Figure 33. Information used to choose Mill Bites
(Participants who chose Mill Bites: n=2,881)

Results of Question 46 - Click on the information you used to make your choice? MULTIPLE ANSWERS ALLOWED* *Because participants were able to give multiple answers, total mentions may exceed 100%.

There were no differences among proposed or alternate subgroups when it comes to information used to choose the Mill Bites' crackers (Table 27).

Table 27. Information used to choose Mill Bites - by proximity of other nutrition information (Participants who chose Mill Bites: n=2,881)

Almost half of participants who chose the Gellar's crackers (46%) used the FOP nutrition symbol to make their incorrect choice. Just over a third (37%) used the Food Star rating, and just under a third (31%) used the food image (Figure 34).

Figure 34. Information used to choose Gellar's (Participants who chose Gellar's: n=720)

Results of Question 46 - Click on the information you used to make your choice? MULTIPLE ANSWERS ALLOWED* *Because participants were able to give multiple answers, total mentions may exceed 100%.

There were no differences among proposed or alternate subgroups when it comes to information used to choose the Gellar's crackers (Table 28).

Table 28. Information used to choose Gellar's - by proximity of other nutrition information (Participants who chose Gellar's: n=720)

A third of participants who chose the Specter & Sons (36%) mentioned using the FOP nutrition symbol to make their incorrect choice and a similar proportion (32%) used the "Source of fiber" claim (Figure 35) to make their incorrect choice. A higher proportion of participants with adequate HL (44%) than those with marginal HL (31%) used the source of fibre claim to make the incorrect choice.

Figure 35. Information used to choose Specter & Sons (Participants who chose Specter & Sons: n=448)

Results of Question 46 - Click on the information you used to make your choice? MULTIPLE ANSWERS ALLOWED* *Because participants were able to give multiple answers, total mentions may exceed 100%.

There are no significant differences between the proposed and alternate subgroups for restriction or without restriction of other nutrition information on the front of the package (Table 29).

Table 29. Information used to choose Specter & Sons - by proximity of other nutrition information (Participants who chose Specter & Sons: n=448)

Results of Question 46 - Click on the information you used to make your choice? MULTIPLE ANSWERS ALLOWED* *Because participants were able to give multiple answers, total mentions may exceed 100%.

2.5 Additional Comments Regarding Consumers Access, Understanding, Appraisal, and Use of the FOP Nutrition Symbol

After finishing their shopping tasks, almost all participants (94%) said that the FOP nutrition symbols were helpful when making their food choices (Figure 36). Almost three-quarters (71%) of participants of varying HL levels rated the helpfulness of the FOP nutrition symbol as 6 or 7 on a scale of 1 (not at all helpful) to 7 (very helpful).

Figure 36. Level of helpfulness of the FOP nutrition symbol (%) (n=4,049)

Results of Question 48 - Now that you have finished your shopping tasks, how helpful were these nutrition symbols when you were making your food choices?

The FOP nutrition symbol was considered helpful by participants of varying HL levels when making food decisions mainly because it was easy for them to see which foods are high in saturated fat, sugars, or sodium (62%) and it helped them to compare products (58%) (Figure 37). About four out of ten mentioned that it helps them think about how often (41%) and how much at one time (40%) they might eat this food. One third (32%) also said the FOP nutrition symbol makes them consider if they really wanted to buy a food product with a FOP nutrition symbol, whereas 21% thought that the FOP nutrition symbol only confirmed what they already know about the food product (Figure 37).

Figure 37. Reasons why the FOP nutrition symbol was helpful when making food choices (n=3,791)

Results of Question 50 - Why? MULTIPLE ANSWERS ALLOWED* (Participants who said the FOP nutrition symbol was helpful when making food choices *Because participants were able to give multiple answers, total mentions may exceed 100%.

Participants considered taste being more important (32%) and not understanding how much sugars, sodium or saturated fat is considered "high" (32%) as the main reasons why they felt the FOP nutrition symbol was not helpful when making food choices (Figure 38). A quarter of participants felt that the FOP nutrition symbol doesn't tell them anything new (26%) and they are simply not worried about sugars, saturated fat, or sodium (26%). A similar proportion (23%) of participants mentioned that other nutrients are more important to them. Two out of ten (21%) don't trust the FOP nutrition symbol. Larger proportions of participants with adequate HL than those with marginal HL said that the FOP nutrition symbol was not helpful when making food choices because it doesn't tell them anything new (45%), because they don't know how much sugars, sodium or saturated fat is considered 'high' (46%), or that other nutrients are more important to them (36%).

Figure 38. Reasons why the FOP nutrition symbol was not helpful when making food choices (n=238)

Results of Question 49 - Why? MULTIPLE ANSWERS ALLOWED* (Participants who said the FOP nutrition symbol was not helpful when making food choices*Because participants were able to give multiple answers, total mentions may exceed 100%.

When asked if they had anything else they would like to comment on about the FOP nutrition symbol, one quarter (26%) of the participants of varying health literacy levels provided comments (Table 30). Positive comments referred to the usefulness of a FOP nutrition symbol (35%) as well as its ease of noticeability (10%). Additional comments included other suggestions for labelling of foods. The most popular suggestion was to add more details (13%) or to warn against others things such as processed food, gluten or GMO'S (5%). Only a minority had negative comments, such as the fact that they did not trust the FOP nutrition symbol (3%) or that the FOP nutrition symbol is confusing (4%).

Table 30. Other comments about the FOP nutrition symbol - by HL (Participants who provided additional comments about the FOP nutrition symbol: n=946)

Results of Question 51 - Is there anything else you would like to tell us about the nutrition symbol? SPONTANEOUS MENTIONS

2.6 Conclusion

The proposed labelling approach, including format requirements related to size, location, and Health Canada attribution, was shown to be effective in providing participants of varying HL levels with quick and easy guidance on foods that are high in sugars, sodium and/or saturated fat. The proximity of other nutrition information had little effect on consumers' understanding and use of the FOP nutrition symbol. However, the presence of other nutrition information can impact the use of the FOP nutrition symbol, such that it may not be the primary source of information on the front of the package used when making a food choice.

Appendix A - Detailed Research Methodology

A.1 Methods

This consumer research was conducted via online surveys, using Computer Aided Web Interviewing (CAWI) technology. As a Certified Gold-Seal MRIA Member, Leger adheres to the most stringent guidelines for quantitative research. The survey has been registered with the MRIA in accordance with Government of Canada requirements for quantitative research, including the MRIA Code of Conduct and Standards of the Conduct of Government of Canada Public Opinion Research - Series D - Quantitative Research.

Participants were assured of the voluntary and confidentiality aspect of the approach and of the anonymity of their responses. As with all research conducted by Leger, all information that could allow for the identification of participants was removed from the data, in accordance with the Privacy Act of Canada.

The French and English questionnaires are available in Appendix B.

Computer Aided Web Interviewing (CAWI)

A panel-based Internet survey was conducted by Leger and included 4,049 adults responsible for their household food purchases in Canada. Participant selection was done randomly from LegerWeb's online panel.

Leger owns and operates an Internet panel of more than 400,000 Canadians from coast to coast. The LegerWeb panel is made up of Web users profiled on different sociodemographic variables. The majority of Leger's panel members (61%) have been recruited randomly over the phone over the past decade, making it highly similar to the actual Canadian population on many demographic characteristics.

Because an Internet sample (from a panel) is non-probabilistic in nature, the margin of error cannot be calculated. Indeed, because the sample is based on those who initially self-selected for participation [in the LegerWeb panel], no estimates of sampling error can be calculated. Because participants for this survey were selected among those who have registered to participate in online surveys, the results of this survey cannot be described as statistically projectable to the Canadian population as a whole.

LegerWeb Online Panel

For several years now, Leger had been conducting online surveys and this method is increasingly preferred because of the speed of operation, the flexibility it allows, especially when presenting visuals, and the reliability of results.

Our testing reveals that results obtained in online surveys concord statistically with those obtained in phone surveys. The validity of online surveys rests on three determining factors: 1) the validity of participants, 2) the validity of responses and 3) the expertise of a team dedicated to online surveys.

The Validity of Participants

Our online surveys are conducted with a panel of Internet users. Our panel has more than 400,000 Canadians and grows each month by 10,000 new panelists. This impressive panel allows us to conduct surveys with the public, but also with specific clienteles. For example, some segments of the population are more difficult to reach, such as people who travel often, workers, young people, and consumers of specific products. In addition, this volume provides close sample control and strict quality control measures.

To ensure the most representative participants for our online surveys, we have developed a proven sampling method. By cross tabulating data related to gender, age, language and region, we can establish a target group, minimize error, and provide a better respect of quotas or eligibility criteria.

Panelists were recruited through complementary methods: telephone recruitment, e-mail invitations, links between sites and invitations using a reference system.

Data from our panel is secured though a private system accessed with a password that panelists receive when invited to answer an online survey.

To foster participation and increase response rates, each panelist invited to answer a questionnaire online has a chance to win a prize drawn each month.

Moreover, to guarantee respondent quality, the LegerWeb team manages the panel database on a continual basis.

The Validity of Responses

By answering an online survey, participants feel they represent an anonymous portion of a targeted group, providing reassurance regarding response confidentiality and validity. Also, the questionnaire must be designed with a minimum number of clicks and a reasonable number of questions because experience has shown that after a certain amount of time participants loose interest and may no longer answer properly.

In addition, a pre-test with 30 participants was essential to identify (and repair as required) any skip errors between questions, to respect screening criteria, and to check navigation fluidity from one question to the next, as well as interview duration. During the pre-test, panelists were invited to provide comments after having answered the questionnaire. This information was used to improve the questionnaire. Client representatives involved in the project participated in this validation process by testing the questionnaire online.

A process of elimination was applied to avoid keeping a questionnaire in which question fatigue ratios were detected at the end of the questionnaire.

The Expertise of a Team Dedicated to Online Surveys

The LegerWeb team includes about ten professionals and technicians who specialize in information technology and e-marketing and who ensure follow-up from 8h00 AM to 7h00 PM every day of the week. Most members of our team come from the fields of telephone polling or face-to-face interviews, and draw on their mastery of the art of the interview.

With its customer support, the LegerWeb team provides panelists with all the technical information and assistance they may need when answering an online survey.

The LegerWeb team works in close collaboration with the research and statistics teams and shares all pertinent information concerning the study. Constant communication allows us to proceed very quickly, to detect errors or problems as soon as they arise and to resolve them in record time.

Software developed by the LegerWeb team to conduct online surveys was designed to allow maximum flexibility, efficiency and security when administering the questionnaire. Furthermore, the team performs continuous monitoring of each online survey.

Leger uses the most recent innovations in the field of online surveys and acts in full knowledge of the limits and possibilities of research performed through online surveys.

Finally, it should be noted that Leger strives to develop its expertise in online surveys by implementing the same quality standards and criteria from its renowned telephone surveys.

Also, for all our quantitative research projects, Leger has established quality control measures that are identical to the ISO process, in which all stages are verified, allowing us to verify previous stages as well. The quality assurance process is based on the following elements:

• Designating a project manager responsible for final product quality to avoid diluting responsibility internally;
• Verifying that client objectives match the final questionnaire, making sure that all are addressed in the questionnaire;
• Verifying questions are clear and easy to understand
• Verifying the effects of contamination a priori, i.e., that the location of each question in the survey overall does not have undue effects on the following responses (generally by providing information indirectly to participants, making the sample un-representative);
• Verifying the online version of the questionnaire with the reference questionnaire approved by the client;
• Before the pre-test, verifying programmed skips in the online questionnaire;
• Conducting a pre-test, which assesses understanding of questions and concepts, possible ambiguities, and logical question skips, etc.;
• The highly vigilant LegerWeb team detects all questions with problems while in the field;
• The use of software prevents data entry errors, non-established skips, etc. Logical validation is therefore done before- in-field implementation;
• Coding of open-ended questions is done with a first sample selection of responses on file and by setting up the codes, which are submitted to the client for approval.

We consider that the implementation of all these procedures is a guarantee of optimal quality when conducting online surveys.

Data Cleaning

Upon completion of data collection, Leger's data analysts and data processing department cleaned the data thoroughly, ensuring that:

• all closed-ended questions were within the allowable or logical range (allowable ranges was confirmed with the client under all circumstances, whether or not it is obvious from the questionnaire);
• outliers were verified and, if necessary, excluded from the data;
• all skip patterns was followed correctly;
• the data was complete (except where it is intentional and within client expectations); and
• information was consistent and logical across questions, with no contradictions in the data.

The data was checked and cleaned after the first night of fieldwork and at project completion. During analysis, all data and any outliers were verified to ensure the data had been entered accurately.

Data Analysis

Our initial analysis of the data via our computerized tabulation software comprised of simple frequencies and central trend measurements; means and medians. Bivariate analysis techniques (such as cross-tabulations and comparison of averages) were then used to study the relationships between variables. Cross-tabulations based on socio-demographic variables and any identified segmentation variables (such as adequate and marginal HL or proposed and alternate version of packaging, Health Canada attribution,) were then conducted in order to further analyze the data.

Successful choice and the time to make the choice were analyzed quantitatively. Pooling of the results from the 4 symbol design arms was conducted and results compared across proposed and alternate labelling subgroups to assess differences due to FOP nutrition symbol size, location, Health Canada attribution, and proximity of claims. For success rates (Questions Q36-Q40), related summary statistics of success rates by different variables of interest were produced to gain insights. Logistic regression analysis with stepwise model selection was used to study the potential effect of the related explanatory variables (i.e., HL, proposed vs. alternative FOPL size/location/clutter, Health Canada attributions), as well as the interactions between these variables on the success rate. For significant findings, nonparametric test methods such as Fisher's exact test was used to confirm the findings.

For response time (Questions Q36 -Q40), only the records with response time<=180 sec. were considered., Related summary statistics (i.e., size, mean, standard deviation, percentiles) by different variables of interest were produced to gain insights. Linear regression models with different selection methods such as forward selection/backward elimination were used to study the potential effect of the explanatory variables to the response time. The significant findings were also confirmed by the nonparametric tests such as Wilcoxon nonparametric method (based on MC method) with Bonferroni's correction.

A.2 Data Collection

Fieldwork for the survey was conducted between March 19, 2018 and March 29, 2018. The participation rate for the survey was 3.3%. A pre-test of 102 interviews in English was completed on March 19, 2018 and a pre-test of 54 interviews in French was completed on March 21, 2018. Survey interviews lasted 16 minutes on average. The final sample consists of 4,049 participants.

As with all research conducted by Leger, contact information was kept entirely confidential and all information that could allow for the identification of participants was removed from the data, in accordance with the Privacy Act of Canada.

A.3 Sampling Procedure

Pan-Canadian Sample of adult grocery shoppers

We constructed a pan-Canadian sample that was randomly selected from the LegerWeb panel. The initial sample was selected to be representative of the Canadian population in terms of gender, age, first language and province of residence.

This approach was used to ensure that a sufficient number of participants within each region of Canada (Table A1) and to ensure a good distribution of participants in terms of gender (men and women) and first language (English and French-speaking Canadians).

Table A1. Regional Distribution of the Starting Sample

A fixed quota was set on the HL status of the participants. To ensure there were enough participants with marginal HL in our final sample, we implemented a quota to include 60% of participants with marginal HL and 40% of participants with adequate HL. Table A2 show the quota that was set to reach this criterion.

Table A2. Target and Effective sample by HL

Unsurprisingly, LegerWeb panelists have higher HL (and were more educated) than the actual population. The pre-test showed almost 76% of the participants had adequate HL and 24% had marginal HL. Given this, we reached the quota of adequate HL participants much sooner than the marginal HL participant quota. Once the first quota was reached the survey was "closed" for participants with adequate HL and only those with marginal HL were able to complete the questionnaire.
Since the objective of the research was less to produce a representative sample of the Canadian population than to compare two groups of Canadians with different HL, the final data have not been weighted as it is usually done with POR research among the general population.

A.4 Participation Rate for the Mock Package Trial

The overall response rate for this study is 3.3%.

Table A3 summarizes the calculation of this study's participation rate. The calculation of the participation rate is as follows: Participation rate = Number of completed questionnaire / Total number of completed sent.

Table A3. Participation Rate

A.5 Non-Response Bias and Additional Socio-Demographic Analysis

An effective response rate of 3.3% is a low participation rate for a national Web survey of 4,049 participants conducted in about two weeks with Canadians adults. However, a low participation rate was expected because of the quota on HL status. The quota of adequate HL participants was reached much sooner than the marginal HL quota. In fact, towards the end of the fieldwork, 9,290 eligible participants that would have been attributed to the "adequate" sample were screened out due to the full quota. This had a major impact on the participation rate.

A.6 Participant Profiles

Table A4 details participants' demographic characteristics. Quotas were established to ensure a good distribution of participants representing the profile of the actual Canadian population in terms of HL, language, and geographical distribution.

Table A4. Participant profiles

A.6.1 Health Literacy Status

The Newest Vital Sign (NVS), a HL screening tool adapted for use in the Canadian (put in reference) was used to assess participants' HL status. The NVS consists of a series of six questions based on the Nutrition Facts table and list of ingredients on a container of ice-cream. Each correct answer is worth one point. A total score of zero or one indicates a high probability of marginal HL. A score of two or three indicates a lower possibility of marginal HL. Finally, a score of four or more indicates adequate HL. Thus participants with total scores between 0 and 3 inclusive were identified as having marginal HL while those with scores of 4 or more were identified as having adequate HL. More than half (59%, n=2,407) scored <4 (at risk of marginal HL) (Figure A1).

Figure A1. Newest Vital Sign scores (n=4,049)

A.6.2 Presence of Health Problems

More than half (51%) of participants were living in a household with someone with health condition(s) that would be impacted by foods high in saturated fat, sodium and/or sugars. 30% of participants self-reported they themselves or someone in their household had high cholesterol, 24% had obesity and 24% had diabetes or pre-diabetes. Fewer had or lived with someone with heart disease (12%), or high triglycerides (9%) (Figure A2).

Figure A2. Participants with health conditions or living with someone with health conditions (n=4,049)

Results of Question 53 - Do you or anyone in your household have any of the following?
MULTIPLE ANSWERS ALLOWED* total mentions may exceed 100%. (n=4,049)

A.6.3 Food Habits and Label Reading

Three-quarter of participants (74%) of varying levels of HL reported doing at least most if not all of their household's grocery shopping while one in four participants (26%) do only some of it (Figure A3).

Figure A3. Responsibility for household grocery shopping (n=4,049)

Results of Question 1 - How much of your household's grocery shopping do you do?

Taste is the most important criterion when making food choices; almost all participants (94%) said it is important/very important (Figure A4). Taste is closely followed by price (85%), nutritional quality (82%), and ingredients (81%). Finally, six out of ten participants (59%) stated that the convenience or ease of food preparation is important when making food choices.

Figure A4. Importance of various factors when making food choices (n=4,049)

Results of Question 2 - How important are the following to you when making your food choices in a grocery store?

Less than half of participants (40%) described their personal attitude towards food as they eat a healthy diet but find it hard to do every day, whereas a third (32%) eat a healthy diet to stay fit and well (Figure A5). Only one out of five (21%) eat the foods they like and don't worry about the healthiness of the foods. Few (6%) eat a special diet because of a specific health need. A greater proportion of adequate HL participants than those at risk of marginal HL consider it difficult to eat a healthy diet everyday (45% vs. 37% respectively). A slightly higher proportion of participants with marginal HL compared to adequate HL said they eat the foods they like regardless of whether they are healthy (24% vs. 18% respectively).

Figure A5. Personal attitudes towards food (n=4,049)

Results of Question 3 - Please, choose the statement that best describes your personal attitude towards food?

Overall, 90% of participants stated that they often/always/sometimes read nutrition labels on food packages (Figure A6). Few participants rarely (9%) or never (2%) read the nutrition labels on foods. Despite having marginal HL, a large majority (88%) said that they always/often/sometimes read nutrition labels. Few participants with marginal HL (13%) rarely/never read nutrition labels.

Figure A6. Use of nutrition labels on pre-packaged foods (n=4,049)
Results of Question 4 - Do you read nutrition labels on food packages?

A.7 Research Protocol

In order to reach the objectives, a specific research protocol has been developed to evaluate the impact some elements of the FOP nutrition symbol (nutrition symbol size, nutrition symbol location, Health Canada attribution, and the restriction of other nutrition information) and of the food labels have on the consumer's awareness, the consumer's understanding and the consumer's appraisal of foods with a FOP nutrition symbol.

Upon starting the questionnaire, each respondent is randomly assigned a FOP nutrition symbol to evaluate for the remainder of the survey with no exposure to any other FOP nutrition symbol. There are 8 iterations of the FOP nutrition symbol: four symbols designs (black rectangles; red rectangle; exclamation point and magnifying glass) and 2 attribution variations (with Health Canada attribution or without any attribution).

The following table shows the 8 iterations of the FOP nutrition symbol that were evaluated in the study (Table A5). All symbols were bilingual.

Table A5. Sampling - part 1

The sample was first randomized in two: with attribution to Health Canada and without attribution to Health Canada and was further randomized to see one of four FOP nutrition symbol designs. Finally, each of the eight sub-samples was randomized into proposed or alternate subgroups. See Table A6 below.

Table A6. Sampling - part2

For each shopping experience task, the time participants took in order to complete the specific task was recorded. This allows precise tracking of the time, in seconds, that each task took for each sub-group of the sample.

Outlier values

In this study, there was no control over the participants while they are completing the survey (as there are during a phone or face to face interview because of the presence of the interviewer). Therefore, some participants might have been doing other activities while they were completing the online survey (like answering the phone) or they may have stopped answering for a prolonged duration of time before coming back to the survey. To prevent outliers from skewing the final results, data from timed tasks that were over three minutes were omitted from the calculation of the mean. All other responses from these participants were included

The Survey

The online survey was designed to simulate a food shopping experience. Health Canada provided Leger with two-dimensional mock package designs of seven food categories: cereal, popcorn, beverage, yogurt, salad dressing, crackers (with a cheese) and canned soup. These foods represented different size portions, package shapes and sizes, and use: meal, snack, treat. Each of these mock packages had regulated labelling information and some included the FOP nutrition symbol in different locations of the label and in different sizes.

For a few questions, all products within the category were shown to participants. This was the case for the cereal, beverage, salad dressing and crackers. However, for a few other questions, more specifically those about crackers, popcorn, yogurt and canned soup, only one product, chosen randomly, was shown to participants. This was done to control the variables related to the food packaging. All products and their high in nutrients are summarized in Table A7.

Table A7. Mock-up products and corresponding high in nutrients

The questionnaire contains three sections with different objectives:

Part A - Introduction to Health Canada's "High In" FOP nutrition symbol
The objectives of the introductory task are:

1. To introduce the FOP nutrition symbol to study participants for subsequent tasks
2. To examine the importance of the Health Canada attribution
3. To explore initial awareness, understanding, appraisal and use of the FOP nutrition symbol in food decisions

Part B - Awareness and Understanding Module (Size, location, clutter)
The objectives of this module are to examine the impact of:

1. The size of the FOP nutrition symbol on consumer awareness and understanding
2. The location of the FOP nutrition symbol on consumer awareness and understanding
3. The clutter of other front of package information around the FOP nutrition symbol on consumers' awareness and understanding of the FOP nutrition symbol

Part C - Appraisal and Use Module (proximity of other nutrition information)
The objectives of the shopping module are to:

1. Explore how the proximity of positive regulated nutrition information (e.g., health/nutrient content claims, other summary FOP symbol) affects consumers' appraisal and use of Health Canada's FOP nutrition symbol in making food decisions
2. Highlight any other issues regarding consumer access, understanding, appraisal, and use of the FOP nutrition symbols

Research Hypotheses

This research protocol will help validate or reject the following research hypotheses:

1. "Proposed" FOP nutrition symbol with the Health Canada attribution is more effective than the "alternate" (without attribution);
2. The "proposed" FOP nutrition symbol size is more effective than the "alternate" (smaller);
3. The "proposed" location (consistently top 25%, right 25% of PDP) is more effective than the "alternate" (bottom 65%, left 65%, or inconsistent locations);
4. The "proposed" proximity of other regulated nutrition information is more effective than "alternate" (close proximity to FOP nutrition symbol).

Appendix B - Survey Questionnaire

FRONT OF PACK CONSUMER RESEARCH PHASE II NUTRITION LABELLING - ENGLISH VERSION
PROGRAMMING INSTRUCTIONS:
[PROJECT TYPE: WebWebWeb]
[LANGUAGES: FR/ENFR/ENFR/EN]
[TRACKING: No]

LANG
Préféreriez-vous répondre à ce questionnaire en anglais ou en français
Would you prefer to complete the survey in English or French?

Label Value Attribute Termination
English EN
Français FR

[SHOW TO ALL]
[INFORMATION AND CONSENT FORM]

Researchers at Health Canada are doing a study on nutrition labels on packaged foods and beverages. You have been asked to take part in this study.

Why are we inviting you to participate in this research project?

We know that many people find it hard to understand food labels. Your participation will help Health Canada to make food labels easier for people to understand and use.

What will we be doing in this research project?

We are asking people to take part in a web based survey on their computer.

You will be asked to look at examples of food labels on packaged foods.

You will be asked to make food choices and answer questions on what food label information helps you to determine which foods are high in saturated fat, sugar, and/or sodium.

The survey will take about 15 minutes to do.

Can I be in the research project?

Yes, you can if….
You do some or most of the grocery shopping for your household.
You have access to a computer with an internet connection.
You can speak and read English or French.
You are at least 18 years old.
You can understand everything on this page.

What if I start the research project and then want to stop? Can I do that?

Yes. Once you start the research project, you can stop at any time. You won't have to explain why you want to stop.
If you decide to stop, none of the information we have collected from you will be used in the analysis, but researchers will use some information such as your age, and gender, if you have provided it, to examine if there are any differences among participants who did not want to take part in the study. The remaining results of your survey responses will be discarded.

Do I have to answer every question in the survey?

No. You are free to select "I prefer not to answer" or "I do not know" options.

Do I get any benefit from being in the research project?

You will receive compensation points for completing this survey from Léger, as per the email you received with this link. If you do wish to withdraw from the survey at any point in time, you will NOT receive any compensation points, as per Leger policy.

What will we do with the results of the research project?

The results of this study will be used by Health Canada to inform the development of regulations for front of package labelling tools for foods high in saturated fat, sodium and /or sugar.

The results of this study will be used in a research report written by Léger Inc.

Health Canada will share this research report with all Canadians on the Library and Archives Canada website.

Health Canada will also prepare a scientific report of the findings and publish them in a scientific journal. Your name will not be used in any of these documents.

Your Rights

You might have questions about your rights as a person in this research project. You might also want to confirm that this research project has been approved and is safe for you to be in.

If you have any questions about this research, you can contact:
Elizabeth Mansfield, Health Canada
Telephone: 613-957-3841
Email: beth.mansfield@canada.ca

If you have questions about your rights as a research participant, you may contact:
Manager, Research Ethics Board of Health Canada
Telephone: 613-941-5199
Email: mailto:REB-CER@hc-sc.gc.ca

Privacy Notice

The personal information you provide to Health Canada is governed in accordance with the Privacy Act. We only collect the information we need to conduct the research project "Front of Pack Consumer Research Phase II" under Section 4 of the Department of Health Act.

For more information: This personal information collection is described in the standard personal information bank Public Communications - PSU 914, in Info Source, available online at infosource.gc.ca.

Your rights under the Privacy Act: In addition to protecting your personal information, the Privacy Act gives you the right to request access to and correction of your personal information. For more information about these rights, or about our privacy practices, please contact Health Canada's Privacy Coordinator at 613-948-1219 or privacy-vie.privee@hc-sc.gc.ca. You also have the right to file a complaint with the Privacy Commissioner of Canada if you think your personal information has been handled improperly.

[ASK SEXE TO ALL]
[SINGLE MENTION]
SEXE
You are…?

Note: As indicated by Statistics Canada, transgender, transsexual, and intersex Canadians should indicate the sex (male or female) with which they most associate themselves.

[ASK AGE TO ALL]
[SINGLE MENTION]
AGE
How old are you?

INTERVIEWER INSTRUCTIONS: (READ LIST)

[ASK LANGU TO ALL]
[SINGLE MENTION]
LANGU
What is the language you first learned at home in your childhood and that you still understand?

[ASK PROV TO ALL]
[SINGLE MENTION]
PROV
In which province or territory do you live?

[ASK POSTAL3 TO ALL]
[OPEN TEXT: VALIDATION - FORCE THE TEXT FORMAT TO BE A9A]
POSTAL3

Please indicate the first 3 characters of your postal code.
If you would rather not provide it, please select I don't know/I prefer not to answer

INTERVIEWER INSTRUCTIONS: (RECORD THE POSTAL CODE IN THE FORMAT A9A)

SCOLA
What is the highest level of education that you have completed (diploma obtained)?

INTERVIEWER INSTRUCTIONS: (READ LIST. SINGLE MENTION ONLY)

QSCTELIG

[ASK ALL]
[SINGLE MENTION]
[LIST ORDER: In order]
Q#1.

How much of your household's grocery shopping do you do?

RESPONDENT INSTRUCTION:

QSCT Importance of food attributes in food choices

[ASK ALL]
[SINGLE MENTION GRID]
[LIST ORDER: In order]
[STATEMENT LIST ORDER: Randomized]
Q#2.

How important are the following to you when making your food choices in a grocery store:

RESPONDENT INSTRUCTION:

[RESPONSE LIST (Scale):]

[STATEMENT LIST]

QSCT Attitudes towards healthy eating

[ASK ALL]
[SINGLE MENTION]
[LIST ORDER: Randomized]
Q#3.

Please, choose the statement that best describes your personal attitude towards food?

RESPONDENT INSTRUCTION: Please select one.

QSCT Label reading

[ASK ALL]
[SINGLE MENTION]
[LIST ORDER: In order]
Q#4.

Do you read nutrition labels on food packages?

RESPONDENT INSTRUCTION: Please select one.

QSCT Health Literacy Assessment

[PROGRAMMER NOTES: Please include "This information is on the back of a 500-ml container of ice cream." above the NFt]

This information is on the back of a 500-ml container of ice cream.

[ASK ALL]
[SINGLE MENTION]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Please include "This information is on the back of a 500-ml container of ice cream." above the NFt]

Q#5.

This information is on the back of a 500-ml container of ice cream.

If you eat the entire container, how many Calories will you eat?

RESPONDENT INSTRUCTION: Please select one.

[ASK ALL]
[SINGLE MENTION]
[LIST ORDER: Randomized]
Q#6.

If you are allowed to eat 60 grams of carbohydrates as a snack, how much ice cream could you have?

RESPONDENT INSTRUCTION: Please select one.

[ASK ALL]
[SINGLE MENTION]
[LIST ORDER: Randomized]
Q#7.

Your doctor advises you to reduce the amount of saturated fat in your diet. You usually have 42 g of saturated fat each day, which includes one serving of ice cream. If you stop eating ice cream, how many grams of saturated fat would you be eating each day?

RESPONDENT INSTRUCTION: Please select one.

[ASK ALL]
[SINGLE MENTION]
[LIST ORDER: Randomized]
Q#8.

If you usually eat 2,500 Calories in a day, what percentage of your daily value of Calories will you be eating if you eat one serving of ice cream?

RESPONDENT INSTRUCTION: Please select one.

[PROGRAMMER NOTES: IF Q5=4 and Q6=2 and Q7=3 and Q8=2 THEN SKIP Q9 and Q10 AND CLASSIFY THEM AS "Adequate Health Literacy".]

[ASK ALL]
[SINGLE MENTION]
[LIST ORDER: In order]
Q#9.

Pretend that you are allergic to the following substances: penicillin, peanuts, latex gloves and bee stings. Is it safe for you to eat this ice cream?

RESPONDENT INSTRUCTION: Please select one.

[ASK Q#10 IF Q9=02]
[SINGLE MENTION]
[LIST ORDER: Randomized]
Q#10.

Why not?

RESPONDENT INSTRUCTION: Please select one.

NVS SCORE CALCULATION
[PROGRAMMER NOTES: Health literacy level based on the score to the NVS test.]
Score by giving 1 point for each correct answer (maximum 6 points).
Score of 0-1 suggests a high likelihood (50% or more) of marginal literacy.
Score of 2-3 indicates the possibility of marginal literacy.
Score of 4-6 almost always indicates adequate literacy.
Label Value Quotas
Score 0 - 3 = Marginal Health Literacy 1 60%
Score 4 - 6 = Adequate Health Literacy 2 40%

SAMPLING PART A

[PROGRAMMER NOTES: Participants will be randomly assigned to see one of eight FOP nutrition symbol variations (one of four FOP nutrition symbol shapes with or without HC attribution). Specifically, participants will be randomly assigned to see a nutrition symbol either with HC attribution (Group A) or without HC attribution (Group B). Participants in each group (Group A and B) will then be randomly assigned to see one of four nutrition symbol variations.]

SPLIT SAMPLE LEVEL #1 - HEALTH CANADA ATTRIBUTION OR WITHOUT HC ATTRIBUTION

SPLIT SAMPLE LEVEL #2 - IMAGE ASSIGNATION
[PROGRAMMER NOTES: A respondent will be assigned to one specific FOP nutrition symbol image for the entire survey. When a respondent is assigned to an image, he will stick with that image until the end of the survey.]

Section Info : Part A - Introduction to the "High In" nutrition symbol
[PROGRAMMER NOTES: This is the introductory task to assess each respondent's awareness of the High In nutrition symbol on the front of pack (FOP) (i.e., did they notice the High In nutrition symbol and interact with it to make their decision). Once they have done this task they will be aware that there is a High In nutrition symbol on FOP of foods that are high in nutrients of public health concern (they will have seen it and able to recognize it). This ensures that everyone is starting on the same page with respect to awareness of the High In nutrition symbol on foods.

QSCT Part A - Introduction to the "High In" nutrition symbol

QSCT Group A - WITH Health Canada attribution (Q11 - Q24)

[ASK Group A]
[SINGLE MENTION]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Show cereal images; 4 images total: 2 images side by side and 2 rows of images]
[PROGRAMMER NOTES: WE NEED TO MEASURE THE TIME SPENT FOR THIS TASK]
Q#11.
Choose a cereal for your household.

RESPONDENT INSTRUCTION: Click on image(s) to see them larger. Please select one.

[ASK Group A]
[SINGLE MENTION]
[LIST ORDER: In order]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#12.

Did you notice these nutrition symbols on any of the cereals?

RESPONDENT INSTRUCTION:

[ASK IF Q12=1]
[MULTIPLE MENTIONS: Max 6]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#13.

How did the nutrition symbol help you make your cereal choice?

RESPONDENT INSTRUCTION: Please select all that apply.

[ASK IF Q13=6]
[SINGLE MENTION]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#14.

Why do you think it was not helpful?

RESPONDENT/INTERVIEWER INSTRUCTION: Please select one.

[ASK IF Q12=1]
[MULTIPLE MENTIONS: Max 8]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes
Q#15.

Which of the following statements describes what the nutrition symbol means to you?

RESPONDENT INSTRUCTION: Please select all that apply.

[ASK IF Q12=2]
[SINGLE MENTION]
[LIST ORDER: Randomized]
[PROGRAMMERS NOTES: Show cereal images; 4 images total : 2 images side by side and 2 rows of images]
[PROGRAMMER NOTES: WE NEED TO MEASURE THE TIME SPENT FOR THIS TASK]

Q#16.

Now that you have seen the nutrition symbol, which cereal would you choose for your household?

RESPONDENT INSTRUCTION: Click on image(s) to see them larger. Please select one.

[ASK IF Answer at Q16 ≠ answer at Q11]
[OPEN QUESTION]
Q#17.

Why did you choose a different cereal?

List for codification

1. I don't want a cereal that is high in sugar
2. I don't want a cereal that is high in saturated fat
3. I don't want a cereal that is high in sodium

[ASK IF answer at Q16 = answer at Q11]
[OPEN QUESTION]
[LIST ORDER: In order]
Q#18.

Why did you choose the same cereal?

List for codification

1. The nutrition symbol reinforced my original choice
2. Taste is more important to me

[ASK IF Q12=2]
[MULTIPLE MENTIONS: Max 7]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#19.

Which of the following statements describes what the nutrition symbol means to you?

RESPONDENT INSTRUCTION: Please select all that apply.

[ASK GROUP A]
[SINGLE MENTION]
[LIST ORDER: In order]
[PROGRAMMER NOTES: Please make a horizontal axis from 1 (at the left) to 7 (at the right)]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#20.

How helpful is it to have ‟Health Canada" as part of the nutrition symbol?

RESPONDENT/INTERVIEWER INSTRUCTION: Please select one.

[ASK IF Q20 = 1 to 3]
[SINGLE MENTION]
[LIST ORDER: Randomized]

Q#21.

Why is it not helpful to have Health Canada as part of the nutrition symbol?

RESPONDENT/INTERVIEWER INSTRUCTION: Please select one.

[ASK IF Q20 = 4 to 7]
[MULTIPLE MENTIONS]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#22.

Why is it helpful to have the words "Health Canada" as part of the nutrition symbol?

RESPONDENT/INTERVIEWER INSTRUCTION: Please select all that apply.

[ASK Group A]
[MULTIPLE MENTIONS]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#23.

What does "Health Canada" in the nutrition symbol mean to you?

RESPONDENT/INTERVIEWER INSTRUCTION: Please select all that apply

[ASK Group A]
[SINGLE MENTION]
[LIST ORDER: Choose an item.]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#24.

How much do you trust this nutrition symbol on foods?

RESPONDENT/INTERVIEWER INSTRUCTION: Please select one.

QSCT Group B - NO Health Canada attribution (Q25 - Q35)

[ASK Group B]
[SINGLE MENTION]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Show cereal images with Health Canada attribution; 4 images total: 2 images side by side and 2 rows of images]
[PROGRAMMER NOTES: WE NEED TO MEASURE THE TIME SPENT FOR THIS TASK]

Q#25.

Choose a cereal for your household

RESPONDENT INSTRUCTION: Click on image(s) to see them larger. Please select one.

[ASK Group B]
[SINGLE MENTION]
[LIST ORDER: In order]

[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#26.

Did you notice these nutrition symbols on any of the cereals?

[ASK IF Q26=1]
[MULTIPLE MENTIONS: Max 6]
[LIST ORDER: Randomized]

[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#27.

How did the nutrition symbol help you make your cereal choice?

[ASK IF Q27=6]
[SINGLE MENTION]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#28.

Why do you think it was not helpful?

RESPONDENT/INTERVIEWER INSTRUCTION: Please select one.

[ASK IF Q26=1]
[MULTIPLE MENTIONS: Max 7]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#29.

Which of the following statements describes what the nutrition symbol means to you?

RESPONDENT INSTRUCTION: Please select all that apply.

[ASK IF Q26=2]
[SINGLE MENTION]
[LIST ORDER: Randomized]

[PROGRAMMERS NOTES: Image of the 3 FOP symbols which are shown on cereal boxes
[PROGRAMMER NOTES: WE NEED TO MEASURE THE TIME SPENT FOR THIS TASK]

Q#30.

Now that you have seen the nutrition symbol, which cereal would you choose for your household?

RESPONDENT INSTRUCTION: Click on image(s) to see them larger. Please select one.

[ASK IF ANSWER AT Q30 ≠ ANSWER AT Q25]
[OPEN QUESTION]
Q#31.

Why did you choose a different cereal?

List for codification

1. The nutrition symbol reinforced my original choice
2. Taste is more important to me

[ASK IF Q26=2]
[MULTIPLE MENTIONS: Max 7]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Image of the 3 FOP symbol which are shown on cereal boxes ]

Q#33

Which of the following statements describes what the nutrition symbol means to you?

RESPONDENT INSTRUCTION: Please select all that apply.

[ASK Group B]
[SINGLE MENTION]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#34.

Who do you think is responsible for this nutrition symbol on foods that are high in saturated fat, sodium, and/or sugar?

RESPONDENT/INTERVIEWER INSTRUCTION: Please select one.

[ASK Group B]
[SINGLE MENTION]
[LIST ORDER: In order]
[PROGRAMMER NOTES: Image of the 3 FOP symbols which are shown on cereal boxes

Q#35.

How much would you trust this nutrition symbol on foods?

RESPONDENT/INTERVIEWER INSTRUCTION: Please select one.

Section Info: Part B - Awareness & Understanding of the "High In" nutrition symbol on FOP

[PROGRAMMER NOTES: The objectives of this module are to examine the impact of:

• the size of the FOP nutrition symbol on consumers' ability to notice and understand the FOP nutrition symbol;
• the location of the FOP nutrition symbol on consumers' ability to notice and understand the FOP nutrition symbol;
• clutter of other front of package information around the FOP nutrition symbol on consumers' ability to notice and understand the FOP nutrition symbol.

For this task each participant will see the nutrition symbol based on the FOP group they have been randomized into. Participants in Groups A and B will be randomly assigned to view nutrition symbols with either the proposed size, location, and clutter OR an alternate size, location, and clutter.]

SPLIT SAMPLE LEVEL #3 - SIZE LOCATION CLUTTER TESTING

[PROGRAMMER NOTES: Participants in Groups A and B will be randomly assigned to view nutrition symbols with either the proposed size, location, and clutter OR an alternate size, location, and clutter. Always keeping their ASSIGNED IMAGE AT THE SPLIT LEVEL 2.

QSCT Part B - Awareness & Understanding of Health Canada's "High In" nutrition symbol (Q36 - Q40)

Section Info
[SHOW ALL]
In this next section you will be asked to do some tasks with different food products one at a time on the screen.

[ASK ALL]
[SINGLE MENTION]
[PROGRAMMER NOTES: Participants in the proposed group (green) will see food products with FOP nutrition symbols of the proposed size. Participants in the alternate group (orange) will see the same food products but with much smaller FOP nutrition symbols. The placement of and clutter of other food product information around the FOP nutrition symbol will be constant across groups and follow the proposed regulatory specifications.]
[PROGRAMMERS NOTES: SHOW IMAGE ON SCREEN: 1 IMAGE - PROGRAM WITH IMAGE MAPPING FOR DIFFERENT ELEMENTS ON THE PACKAGE]
[PROGRAMMERS NOTES: SHOW PROPOSED SIZE OR ALTERNATE SIZE BASED ON THE SPLIT SAMPLE LEVEL 3]
[THE THREE CRACKERS BRANDS NEED TO BE RANDOMIZED - EACH BRANDS (3) SHOULD BE USED EQUALLY]
[PROGRAMMERS NOTES: INCLUDE A TIME VARIABLE IN SECONDS FOR THIS QUESTION]

Q#36.

Click on the nutrition symbol on this food product.

[ASK ALL]
[MULTIPLE MENTIONS: Max: 3]
[LIST ORDER: Randomized]
[PROGRAMMERS NOTES: SHOW IMAGE ON SCREEN: 1 IMAGE
[PROGRAMMERS NOTES: SHOW PROPOSED SIZE OR ALTERNATE SIZE BASED ON THE SPLIT SAMPLE LEVEL 3]
[THE THREE POPCORN BRANDS NEED TO BE RANDOMIZED - EACH BRANDS (3) SHOULD BE USED EQUALLY]
[PROGRAMMERS NOTES: INCLUDE A TIME VARIABLE IN SECONDS FOR THIS QUESTION]

Q#37.

What nutrient(s) is this product "high in"?

RESPONDENT/INTERVIEWER INSTRUCTION: Click on image to see it larger. Please select all that apply.

[ASK ALL]
[SINGLE MENTION]
[PROGRAMMER NOTES: Participants in the proposed group (green) will see products with the FOP nutrition symbol consistently in the upper left of the package whereas those in the alternate group (orange) will see the same products with the FOP nutrition symbol in various locations on the package. The size of and clutter around the FOP nutrition symbol will be constant across groups and follow the proposed regulatory specifications.]
[PROGRAMMERS NOTES: SHOW IMAGE ON SCREEN: 1 IMAGE - PROGRAM WITH IMAGE MAPPING FOR DIFFERENT ELEMENTS ON THE PACKAGE]
[THE THREE YOGOURT BRANDS NEED TO BE RANDOMIZED - EACH BRANDS (3) SHOULD BE USED EQUALLY]
[PROGRAMMERS NOTES: SHOW PROPOSED LOCATION/PLACEMENT OR ALTERNATE LOCATION/PLACEMENT BASED ON THE SPLIT SAMPLE LEVEL 3]
[PROGRAMMERS NOTES: INCLUDE A TIME VARIABLE IN SECONDS FOR THIS QUESTION]

Q#38.

Click on the nutrition symbol on this food product.

[ASK ALL]
[SINGLE MENTION]
[LIST ORDER: Randomized]
[PROGRAMMERS NOTES: SHOW IMAGE ON SCREEN: 3 IMAGES SIDE BY SIDE]
[PROGRAMMERS NOTES: SHOW PROPOSED LOCATION/PLACEMENT OR ALTERNATE LOCATION/PLACEMENT BASED ON THE SPLIT SAMPLE LEVEL 3]
[PROGRAMMERS NOTES: Check boxes positioned under the images]
[PROGRAMMERS NOTES: INCLUDE A TIME VARIABLE IN SECONDS FOR THIS QUESTION]

Q#39.

Which product is "high in" sugar and sodium?

RESPONDENT/INTERVIEWER INSTRUCTION: Click on image(s) to see them larger. Choose one salad dressing.

[ASK ALL]
[MULTIPLE MENTIONS]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: Participants in the proposed group (green) will see a cereal with a FOP nutrition symbol and facts up front symbol in the bottom right, whereas those in the alternate group (orange) will see the same product with the same FOP nutrition symbol but with the facts up front symbol right beside the FOP nutrition symbol. The size and location of the FOP nutrition symbol will be constant across groups and follow the proposed regulatory specifications.]
[THE THREE SOUP BRANDS NEED TO BE RANDOMIZED - EACH BRANDS (3) SHOULD BE USED EQUALLY]
[PROGRAMMERS NOTES: SHOW IMAGE ON SCREEN: 1 IMAGE]
[PROGRAMMERS NOTES: SHOW PROPOSED CLUTTER OR ALTERNATE CLUTTER BASED ON THE SPLIT SAMPLE LEVEL 3]
[PROGRAMMERS NOTES: INCLUDE A TIME VARIABLE IN SECONDS FOR THIS QUESTION]

Q#40.

What nutrient(s) is this product "high in"?

RESPONDENT/INTERVIEWER INSTRUCTION: Click on image to see it larger. Please select all that apply.

Section Info : Part C -Appraisal & Use of the "High In" nutrition symbol on FOP

[QUESTIONS TO INCLUDE IN THIS SECTION: ]

[PROGRAMMER NOTES: The objectives of the shopping module are to:

• Explore how the proximity and prominence of positive FOP regulated nutrition information (e.g., health/nutrient content claims, other summary FOP symbol) affect consumers' appraisal and use of the FOP nutrition symbol in making food decisions
• Highlight any other issues regarding consumer access, understanding, appraisal, and use of the FOP nutrition symbols

For this task all participants will see products with their assigned FOP nutrition symbol. However, participants in Groups A and B will be randomly assigned to view products with FOP nutrition symbols in the proposed size and location but either have positive FOP regulated nutrition information far away (proposed) or next to (alternate) the FOP nutrition symbol.

Participants will be given two shopping tasks: a non-specific food choice task followed by a specific food choice task.]

QSCT Part C -Appraisal & Use of the "High In" nutrition symbol (Q41- Q51)

[ASK ALL]
[SINGLE MENTION]
[LIST ORDER: Choose an item.]
[PROGRAMMER NOTES: For the non-specific task, participants will be shown 3 beverages with FOP nutrition symbols and other FOP regulated nutrition information either far away from (proposed) or next to (alternate) the FOP nutrition symbol]
[PROGRAMMERS NOTES: SHOW IMAGE ON SCREEN: 3 IMAGES SIDE BY SIDE]
[PROGRAMMERS NOTES: SHOW PROPOSED OR ALTERNATE BASED ON THE SPLIT SAMPLE LEVEL 3]
[PROGRAMMERS NOTES: Check boxes positioned under the images]
[PROGRAMMERS NOTES: INCLUDE A TIME VARIABLE IN SECONDS FOR THIS QUESTION]

Q#41.

"Imagine the following situation: You have planned to go to the grocery store to buy a fruit beverage. Please look carefully at all the options.

Which beverage would you choose?

RESPONDENT INSTRUCTION: Click on image(s) to see them larger. Choose one beverage.

[ASK ALL]
[MULTIPLE MENTIONS: Max 6]
[LIST ORDER: Randomized]
[PROGRAMMERS NOTES: SHOW IMAGE CHOSEN AT Q#41]
[PROGRAMMERS NOTES: PROGRAM WITH IMAGE MAPPING FOR DIFFERENT ELEMENTS ON THE PACKAGE]

Q#42.

Click on the information you used to make your choice?

RESPONDENT/INTERVIEWER INSTRUCTION: You may click on more than one element on the package

[ASK ALL]
[SINGLE MENTION GRID]
[LIST ORDER: In order]
[STATEMENT LIST ORDER: Synchronized]
[PROGRAMMER NOTES: Show statement and images ONE AT THE TIME according to answer at Q42]
[PROGRAMMER NOTES: Show information of code 2 and 3 according to product chosen at Q45, see in the table below]

Product: AppleJuice, BerryFusion, TropicalTwist
Code 2 Brand name : Apple Juice, Brand name : Berry Fusion, Brand name: Tropical Twist
Code 3 Company name : VELO, Company name : H2O Fountain, Company name : HINTON'S

Q#43.

How helpful is the following to you when making your beverage choice in a grocery store:

RESPONDENT INSTRUCTION:

[STATEMENT LIST]

[ASK ALL]
[MULTIPLE MENTIONS: Max: 7]
[LIST ORDER: Randomized]
[PROGRAMMERS NOTES: SHOW IMAGE CHOOSEN AT Q#41, Please include the high in sugars nutrition symbol beside the beverage]

Q#44.

How did the nutrition symbol affect how you might use this beverage?

RESPONDENT/INTERVIEWER INSTRUCTION: Click on image to see it larger. Please select all that apply.

[ASK ALL]
[SINGLE MENTION]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES: For the specific task, participants will be shown a cheese product with a high in saturated fat FOP nutrition symbol as well as three cracker products with FOP nutrition symbols and other regulated nutrition information either far away from (proposed) or next to (alternate) the FOP nutrition symbol.]
[PROGRAMMERS NOTES: SHOW IMAGE ON SCREEN: 4 IMAGES - 1 CHEESE ON TOP OF THE SCREEN ABOVE THE QUESTION AND 3 IMAGES OF CRACKER SIDE BY SIDE]
[PROGRAMMERS NOTES: SHOW PROPOSED OR ALTERNATE BASED ON THE SPLIT SAMPLE LEVEL 3]
[PROGRAMMERS NOTES: Check boxes positioned under the crackers images]
[PROGRAMMERS NOTES: INCLUDE A TIME VARIABLE IN SECONDS FOR THIS QUESTION]

Q#45.

Imagine the following situation: someone in your household needs to cut down on their saturated fat intake. Which cracker would you choose for them to eat with this cheese? Please look carefully at all the options.

Which cracker would you choose?
RESPONDENT INSTRUCTION: Click on image(s) to see them larger. Choose one cracker.

[ASK ALL]
[MULTIPLE MENTIONS: Max 6]
[LIST ORDER: Randomized]
[PROGRAMMERS NOTES: SHOW IMAGE CHOOSEN AT Q#45]
[PROGRAMMERS NOTES: PROGRAM WITH IMAGE MAPPING FOR DIFFERENT ELEMENTS ON THE PACKAGE]

Q#46.

Click on the information you used to make your choice?

RESPONDENT/INTERVIEWER INSTRUCTION: You may click on more than one element on the package

[ASK ALL]
[SINGLE MENTION GRID]
[LIST ORDER: In order]
[STATEMENT LIST ORDER: Synchronized]
[PROGRAMMER NOTES: Show statement and images ONE AT THE TIME according to answer at Q46]
[PROGRAMMER NOTES: Show information of code 2 and 3 according to product chosen at Q45, see in the table below]

Product: Gellar, Mill_Bites, SpecterSons
Code 2 Brand name : GELLAR'S ORIGINAL, Brand name : Mill Bites, Brand name: ORIGINAL
Code 3 Not applicable, Company name : THE COUNTRY MILLFOOD COMPANY, Company name : Specter&Sons

Q#47.

How helpful is the following to you when making your cracker choices in a grocery store:

[RESPONSE LIST (Scale):]

[STATEMENT LIST]

[ASK ALL]
[SINGLE MENTION]
[LIST ORDER: In order]
[PROGRAMMERS NOTES: SHOW THE FOP IMAGE WITH ALL 3 NUTRIENTS]

Q#48.

Now that you have finished your shopping tasks, how helpful were these nutrition symbols when you were making your food choices

RESPONDENT/INTERVIEWER INSTRUCTION: Please select one.

[ASK IF Q48 = 1 to 3]
[MULTIPLE MENTIONS: Max 10]
[LIST ORDER: Randomized]

Q#49.

Why?

RESPONDENT/INTERVIEWER INSTRUCTION: Please select all that apply.

[ASK IF Q48 = 4 to 7]
[MULTIPLE MENTIONS: Max 6]
[LIST ORDER: Randomized]
[PROGRAMMER NOTES:]
[VALIDATION:]

Q#50.

Why?

RESPONDENT/INTERVIEWER INSTRUCTION: Please select all that apply.

[ASK ALL]
[OPEN-END]
[PROGRAMMER NOTES:]
[VALIDATION:]

Q#51.

Is there anything else you would like to tell us about the nutrition symbol?

INTERVIEWER INSTRUCTION:

QSCTDEMO (Q53)
Before the study comes to an end we need to ask you one more questions about yourself and your household

[ASK ALL]
[MULTIGRID: Max 2]
[LIST ORDER: In order]
[STATEMENT LIST ORDER: Randomized]

Q#53.

Do you or anyone in your household have any of the following?

RESPONDENT INSTRUCTION: Please select all that apply.

[STATEMENT LIST]

QSCT : End of survey
You have reached the end of the survey.
Thank you for your participation!

Please click on the following arrow to receive your reward(s).

[PROGRAMMER NOTES: Mettre les information ci-dessous sur une landing page qui apparaît après que les répondants aient cliqué sur la flèche]

You're invited to comment on Health Canada's proposal for mandatory front-of-package nutrition symbols, for foods high in:

• saturated fat and/or
• sugar and/or
• sodium

Take part in Health Canada's quick and easy online Food Front-of-Package Nutrition Symbol Consultation to help Health Canada's choose which symbol could be used on the front-of-packages

https://www.healthyeatingconsultations.ca/front-of-package

Appendix C - Mock-Ups Examples

Appendix D - Helpfulness of information used to choose products in non-specific and specific tasks

D.1 Non-specific Task (Beverages)

Even though the FOP nutrition symbol was not the most frequently used piece of FOP information among participants who chose Apple Juice, 94% of those participants considered it be a very helpful piece of information (5.80/6) closely followed by the Food Star rating (5.66/6) and the brand name (5.57/6) (Table D1).

Table D1. Helpfulness of the information used to choose Apple Juice; (Participants who chose a criterion of Apple Juice: Base varies among criterion)

Results of Question 43 - How helpful is the following to you when making your beverage choice in a grocery store

The "no sugars added" claim was the preferred piece of FOP information used by at least two thirds of participants of varying HL levels, regardless of its proximity to the FOP nutrition symbol. The FOP nutrition symbol was the second most useful piece of FOP information; however it lagged far behind the reported use of the "no sugars added" claim. Those participants used the FOP nutrition symbol to choose the Berry Fusion rated the FOP nutrition symbol as the most helpful piece of FOP information (5.99/7) (Table D2). This was closely followed by the "no sugars added" claim (5.76/7) and the food image (5.54/7).

Table D2. Helpfulness of the information used to choose Berry Fusion; (Participants who chose a criterion of Berry Fusion: Base varies among criterion)

Results of Question 43 - How helpful is the following to you when making your beverage choice in a grocery store *Note: For this criterion, the balance to 100% corresponds to "Refusal" mentions.

The "100% Juice Blend" marketing claim (5.96/7), the flavour text (5.95/7) and the food image (5.60/7) were the most useful pieces of information for participants when choosing the Tropical Twist beverage. The FOP nutrition symbol was ranked fourth (5.55/7) (Table D3).

Table D3. Helpfulness of the information used to choose Tropical Twist; (Participants who chose a criterion of Tropical Twist: Base varies among criterion)

Results of Question 43 - How helpful is the following to you when making your beverage choice in a grocery store: *Note: For this criterion, the balance to 100% corresponds to "Refusal" mentions.

D.2 Specific Task (Crackers)

The FOP nutrition symbol was the most used information criteria when making the correct choice (Mill Bites) and those participants also ranked it as the most helpful information (6.01/7) (Table D4). It is closely followed by the "25% Reduced Sodium" claim (5.79/7) and the food image (5.71/7). The brand name was also helpful, but in a lesser manner (5.26/7).

Table D4. Helpfulness of the information used to choose Mill Bites (Correct choice); (Participants who chose a criterion of Mill Bites: Base varies among criterion)

Results of Question 47 - How helpful is the following to you when making your cracker choices in a grocery store. *Note: For this criterion, the balance to 100% corresponds to "Refusal" mentions.

Participants choosing the Gellar's cracker (an incorrect choice) ranked the FOP nutrition symbol was the second most helpful information when choosing Gellar's (5.68/7) (Table D5). It is preceded by the food image (5.80). The Food Stars image comes as the third most useful (5.53/7).

The other information used to choose Gellar's were not selected by a sufficient number of participants to draw any conclusions as to the level of assistance provided in the decision-making process.

Table D5. Helpfulness of information used to choose Gellar's (Incorrect choice); Participants who chose a criterion of Gellar's: Base varies among criterion)

Results of Question 47 - How helpful is the following to you when making your cracker choices in a grocery store *Note: For this criterion, the balance to 100% corresponds to "Refusal" mentions.

Although the "Source of fiber" claim was ranked as the most helpful information, participants were using it to make an incorrect choice of cracker for someone in their household who needs to cut down on their saturated fat intake (5.82/7) (Table D6). The FOP nutrition symbol comes close second (5.60/7), followed by the brand name (5.37).

Table D6. Helpfulness of the information used to choose Specter & Sons (Incorrect choice); (Participants who chose a criterion of Specter & Sons: Base varies among criterion)

Results of Question 47 - How helpful is the following to you when making your cracker choices in a grocery store: *Note: For this criterion, the balance to 100% corresponds to "Refusal" mentions.

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