Is this advertisement designed to appeal to you? Adolescents' views about Instagram advertisements promoting ultra-processed products.

OBJECTIVE: Examine the key elements that characterise social media advertisements targeted at adolescents by asking adolescents which features of Instagram ads promoting ultra-processed products make them designed to appeal to adolescents. DESIGN: Instagram ads promoting ultra-processed products and brands were selected from a database in which ads had been classified regarding whether they were primarily targeted at adolescents from an adult perspective. Adolescents completed a sorting task in small groups and were requested to reach a consensus through discussions and sticky notes regarding whether sixty ads were designed to appeal to them. The sorting task was analysed using content analysis based on inductive coding. SETTING: One private secondary school and two after-school clubs. PARTICIPANTS: Convenience sample of 105 Uruguayan adolescents aged 11-17 years. RESULTS: Ten categories were identified regarding the reasons for sorting ads as (not) designed to appeal to adolescents: product type, graphic design, explicit references to age groups, language, activities or themes, memes, celebrities, characters, promotions and novelty. Product type emerged as a key element, with adolescents perceiving ads as designed to appeal to them simply because they promoted specific products. CONCLUSIONS: This research contributes to the validation of criteria defined in previous studies and can be used for the development of tools to monitor the prevalence and power of adolescent-targeted digital marketing. However, the importance attributed to type of product suggests that regulations should not exclusively focus on exposure to digital marketing specifically targeted at adolescents but also on exposure to marketing in general.

Children's reaction to sugar reduced dairy desserts in the context of the implementation of nutritional warning labels: An exploratory study.

The aim of the present work was to explore children's reaction to sugar reduction in the context of the implementation of nutritional warnings in Uruguay. The study was composed of two sessions involving three evaluation conditions: tasting without package information, package evaluation without tasting, and tasting with package information. A total of 122 children, ages ranging between 6 and 13 years old (47% girls) were involved in the study. In the first session, children's hedonic and emotional response to a regular and a sugar-reduced chocolate dairy dessert (without other sweeteners) was evaluated. In the second session, children first evaluated their expected liking, emotional associations and choice of packages differing in the presence of warning labels for excessive sugar content and cartoon character (2x2 design). Finally, they tasted the selected sample in the presence of the package and evaluated their liking, emotional associations, and intention to re-taste it. Although sugar reduction led to a significant reduction in overall liking, the dessert with 40% sugar reduction showed a mean overall score of 6.5 in a 9-point hedonic scale and was described using positive emoji (, , ). When the desserts were tasted with package information, no significant differences in the expected overall liking of the regular and sugar-reduced dessert were found. Regarding the effect of packaging elements, the presence of a warning label highlighting excessive content of sugar did not have a significant effect on children's choice. Instead, children's choices were defined by the presence of a cartoon character. Results from the present work provide additional evidence about the feasibility of reducing the sugar content and sweetness of dairy products targeted at children and stress the need to regulate the use of cartoon characters on products with an unfavorable nutritional profile. Methodological recommendations for sensory and consumer research with children are also discussed.

Use of nutritional warning labels at the point of purchase: An exploratory study using self-reported measures and eye-tracking.

Nutritional warning labels are gaining relevance in the region of the Americas as a policy tool to reduce information asymmetry and encourage healthier food choices. However, empirical evidence about consumer experiences with warning labels after implementation is still scarce. In this context, the aim of the present work was to explore the use of nutritional warning labels after policy implementation in Uruguay, using a combination of eye-tracking and self-reported data. The study was conducted in three supermarkets, in two regional capitals, 19 months after the entry into force of the policy. A total of 224 participants were intercepted while entering the facilities of the supermarket and asked to wear a mobile eye-tracker while making their food purchases. Then, they were asked a series of questions about their awareness and use of warning labels. Although participants reported high awareness and understanding of the labels, active search and use at the point of purchase was low. Only 6% of the consumers declared having actively searched for the warning labels and 7% fixated their gaze on the labels. The majority of the participants (72%) who declared having seen the warnings on a product, purchased it anyway. However, 56% declared having changed their food choice decisions as a consequence of the implementation of the policy. Participants' accounts about reasons for (not) taking into account the warning labels provide relevant insights for the development of strategies to encourage citizens to increase policy effectiveness and encourage healthier food choices.

The Idealization of Infant Formula: A Longitudinal Analysis of Labels in Uruguay.

BACKGROUND: Labels are a key element of the marketing strategies of infant formula companies, and often include text or images that idealize their use, undermining efforts to promote breastfeeding. RESEARCH AIMS: To evaluate the prevalence of marketing cues that idealize infant formula on labels of products commercialized in Uruguay and to assess changes after a periodic monitoring of compliance with the International Code of Marketing of Breast-Milk Substitutes (IC). METHOD: This study is a descriptive, observational, and longitudinal assessment of the information included on infant formula labels. The first data collection was in 2019, as part of a periodic assessment to monitor the marketing of human-milk substitutes. In 2021, the same products were purchased to evaluate changes in their labels. Thirty-eight products were identified in 2019, of which 33 were still available in 2021. All information available on the labels was analyzed through content analysis. RESULTS: Most products included at least one textual or visual marketing cue idealizing infant formula in both 2019 (n = 30, 91%) and 2021 (n = 29, 88%). This represents a violation of both the IC and national regulations. References to nutritional composition were the most frequent marketing cue, followed by references to child growth and development. No relevant changes were observed after the periodic assessment conducted by the Uruguayan government. CONCLUSIONS: Monitoring compliance with the IC per se cannot be expected to trigger changes in the marketing strategies of infant formula companies. More explicit regulations and strong enforcement mechanisms are needed to end the inappropriate marketing practices on infant formula labels.

An exploration of what freshness in fruit means to consumers.

Perceived freshness is a key determinant of consumers' food choices but remains an imprecisely defined concept. A comprehensive and consumer-centric definition of freshness appears to be lacking, and the present research was situated in this knowledge gap, seeking, in particular, to explore the complexity of freshness in consumers' minds. People from the USA (n = 2092) took part in an online survey and completed a text highlighting task. Herein, participants read a text that described different aspects of freshness and the technologies used to prolong freshness during storage. While reading, they used highlighting functions within the software to indicate text content that they liked/disliked or agreed/disagreed with. The combined results from text highlighting and responses to the open-ended question "Considering the fruit you eat, why is freshness important to you?" confirmed that freshness is a complex construct with multiple dimensions and suggested that the complexity of freshness extends from food in general to specific product categories (in the case of fruit and apples). Further, the findings showed that freshness is desired by consumers because fruit are perceived as healthier and better tasting. The findings revealed negative attitudes towards stored fruit among participants, but also indicated some acceptance of the fact that some storage was unavoidable. Results provide useful insights to the development for communication strategies to increase consumer acceptance of stored apples and fruits in general.

Qualitative exploration of the reasons for not using nutritional warnings after policy implementation in Uruguay.

Nutritional warnings have gained popularity, particularly in the region of the Americas, to facilitate the identification of products with excessive content of nutrients associated with non-communicable diseases and encourage healthier food choices. Although warnings have been shown to be effective, an in-depth understanding of the reasons why some consumers do not use them is still lacking. The aim of the present work was to explore self-reported use of nutritional warnings and to identify the reasons for not considering nutritional warnings for making food purchase decisions after policy implementation in Uruguay. A non-probabilistic sample of 858 Uruguayan participants was recruited using an advertisement on Facebook and Instagram. Through an online survey, self-reported use of nutritional warnings was asked using a closed-open ended questions. Participants who reported not considering warnings to make their purchase decisions were asked to explain the reasons why using an open-ended question. Responses were analysed using deductive coding, based on the Behavioural Drivers Model. Thirty seven percent of the participants stated that the warnings had not influenced their purchase decisions. Motives for not being influenced by the warnings were related to lack of interest, attitudes, lack of perceived self-efficacy, cognitive biases and limited rationality when making purchase decisions. In addition, structural barriers, such as availability, cost and trust in the food industry also emerged from participants' responses. Strategies to encourage the use of warnings should include communication campaigns and policies to address structural barriers related to the perceived availability and affordability of healthy foods.

Health-related cues on the packages of processed and ultra-processed products: prevalence and policy implications.

The information included on food packages has a crucial role in influencing consumer product associations and purchase decisions. In particular, visual and textual cues on processed and ultra-processed products can convey health-related associations that influence consumer healthiness perception and purchase decisions. In this context, the present work aimed to explore the use of health-related cues on the packages of processed and ultra-processed products sold in Uruguay to provide insights for policy making. A total of 3813 products from thirty-four different food categories found in four of the most important supermarket chains in Uruguay were surveyed. The textual and visual information included on the packages as well as the nutritional composition of the products were analysed. Results showed that 67 % of the products included at least one health-related cue. Pictures of culinary ingredients, natural and minimally processed foods were the most frequent health-related cue, followed by references to naturalness and claims related to critical nutrients. The prevalence of health-related cues largely differed across product categories, ranging from 100 to 17 %. The relationship between the presence of health-related cues on the packages and the excessive content of nutrients associated with non-communicable diseases was assessed using a gradient boosting model, which showed limited predictive ability. This suggests that the inclusion of health-related cues on food packages was not strongly related to the nutritional composition of products and therefore cannot be regarded as a healthiness indicator. These results stress the need to develop stricter labelling regulations to protect consumers from misleading information.

Data Federation in Healthcare for Artificial Intelligence Solutions.

Data federation offers a way to get data moving from multiple sources providing advantages in healthcare systems where medical data is often hard to reach because of regulations or the lack of reliable solutions that can integrate on top of protocols like FHIR, HL7, DICOM, among others. Given the increasing need for solutions that augment healthcare systems with artificial intelligence (AI), in fields like genomics, cancer treatment, and radiology, all of which will require solutions that can provide data at scale while being traceable, safe, and regulatory-compliant. This paper proposes an architectural solution that may provide the core capabilities to implement a data federation approach in a healthcare system to enable AI.

Meat insights: Uruguayan consumers´ mental associations and motives underlying consumption changes.

A telephone survey (n = 601) was conducted in Uruguay to explore participants' mental associations with meat and the underlying reasons changes in the quantity and type of meat consumed. Participants mentioned mostly positive associations with meat's culinary and cultural aspects and its nutritional value as source of high-quality protein. Other associations were related to meat production, specific types of meat and cuts, meat consumption and pleasure, while price was perceived negatively. Animal welfare concerns emerged as a relevant association, but minor references were made to the effects of meat production on the environment. Changes in the amount and type of meat consumed (higher pork, chicken and cheaper cuts and beef) in the last year were mainly due to price followed by health reasons. Results emphasize the strong meat culture among Uruguayans and reveal that changes in the amount and type of meat consumed last year relate to external (price) or egoistic (health) rather than altruistic motives (ethical or environmental concerns).

'Even if you don't pay attention to it, you know it's there': A qualitative exploration of adolescents' experiences with digital food marketing.

Adolescents are particularly vulnerable to digital food marketing. However, research on adolescents' recall, awareness, and opinions of this type of marketing is still scarce. Accordingly, the present study aimed to conduct an in-depth examination of adolescents' experiences with digital food marketing. A convenience sample of 209 adolescents was recruited at two private educational institutions and a public health facility in Montevideo, the capital city of Uruguay. Semi-structured group interviews were conducted, recorded in audio and transcribed. The transcripts were analyzed using content analysis based on a deductive-inductive approach. Results showed that participants were highly exposed to digital food marketing, as they all remembered having seen advertisements, with those of fast-food restaurants and food-ordering apps being the most frequently mentioned. According to the adolescents' accounts, images, colors, music, oversized portions, product novelty, price promotions and celebrities were the most memorable aspects of food advertisements. Participants recognized the effect of advertisements on product awareness and wanting, and, to a lesser extent, on actual purchase and consumption behavior. Factors that were thought to mediate the impact of digital marketing on food choice were also identified. In the final part of the interviews, participants proposed strategies to reduce the effect of digital marketing on their food choices, which included both regulatory approaches to reduce exposure to digital marketing of unhealthy foods and behavior change communication. Together, the current findings provide insights for the development of multifaceted strategies to reduce the effects of digital food marketing on the eating habits of adolescents.

Consumer perspectives on the inclusion of nutritional warnings in retail food establishments

ABSTRACT The present work aimed to assess Uruguayan consumers support of the inclusion of nutritional warnings on four types of retail food establishments and to obtain consumer insights on how the warnings could be implemented in such establishments. For this purpose, an online survey was conducted with a non-probabilistic sample of 547 participants recruited via an advertisement on social media. Participants were requested to indicate their degree of agreement with the implementation of nutritional warnings in bakeries, delicatessens, fast-food restaurants and while ordering food online, and to provide ideas on how to include this information for each establishment. Results suggested that the inclusion of nutritional warnings in retail food establishments was positively perceived by participants. Participants highlighted that warnings should be highly visible to customers while making purchase decisions, so they become a relevant cue for making food choices. In particular, the retail display case and menu boards were identified as key locations for warnings in bakeries, delicatessen, and fast food restaurants, respectively. These results contribute valuable insights on how to implement the extension of nutritional warnings to unpackaged foods or foods made and packaged at the point of purchase.

RESUMEN El presente trabajo tuvo como objetivo evaluar la percepción de los consumidores uruguayos en relación a la implementación de advertencias nutricionales en cuatro puntos de venta de comida y generar ideas sobre cómo podría implementarse esta medida. Se realizó un estudio online con una muestra no probabilística de 547 participantes, reclutados utilizando publicidad en redes sociales. Los participantes indicaron su grado de acuerdo con la implementación de advertencias nutricionales en panaderías, rotiserías, lugares de venta de comida rápida y sitios de pedidos online, y proporcionaron ideas sobre cómo incluir esta inforamción en cada punto de venta. Los resultados sugieren que la población tiene una perecpeción positiva sobre la inclusión de advertencias nutricionales en puntos de venta de comida. Los participantes destacaron la importancia de incluir esta información en un lugar visible al momento de elegir los productos, de forma que pueda ser tenida en cuenta al tomar las decisiones. En particular, las vitrinas y la cartelería/pizarras fueron identificados como lugares estatégicos para la inclusión de advertencias nutricionales en panaderías/rotiserías y puntos de venta de comida rápida, respectivamente. Los resultados proporcionan valiosa información para extender la inclusión de advertencias nutricionales a puntos de venta de comida.

Age, time orientation and risk perception are major determinants of discretionary salt usage.

The present work explored the relationship between discretionary salt usage and personal characteristics, using boosted regression trees (BRT). Specifically, the focus was on how socio-demographic characteristics and personality traits linked to risk perception and time orientation impact on discretionary salt consumption patterns. For this purpose, an online cross-sectional survey with a convenience sample of 498 Uruguayan participants was carried out. Participants completed the consideration of future consequences (CFC) scale adapted for eating behaviour, a short survey about discretionary salt consumption patterns and indicated their degree of agreement with statements measuring perceived risk of sodium consumption. Finally, socio-demographic data were collected. BRT were applied to build predictive models that related discretionary salt usage to socio-demographic characteristics, the two factors of the CFC-Food scale (consideration of the future and consideration of the immediate consequences of eating behaviour), and the two factors of the perceived risk of sodium consumption scale (severity of perceived risks and risk compensation). Age, time orientation and perceived risk were the most relevant explanatory variables for discretionary salt usage. Older people had a lower likelihood of adding salt to food, either at home or when eating out. In addition, individuals who tend to be present rather than future oriented, as well as those with low perception of risk severity and susceptibility were more likely to add salt to foods. Results from the present work suggest that communication campaigns to reduce discretionary salt intake should mainly focus on stressing the short-term health benefits of reducing sodium intake and raising perceived susceptibility.

How do consumer characteristics influence responses to nutritional warnings?

ABSTRACT The aim of the present work was to explore the influence of consumer characteristics on purchase decisions when facing products with nutritional warnings a few days after their implementation in Uruguay. A non-probabilistic sample of 917 participants was obtained using an advertisement on social media. Participants were asked if they had seen the warning signs when making their food purchases and if they had seen the warnings on any product they intended to buy. Participants who answered affirmately (n= 616) were asked about their purchase decision by answering the question "What have you done with the product?" using the following response options: 'I purchased it anyway', 'I purchased a similar product with fewer excess signs', 'I purchased a similar product without excess signs', 'I didn't purchase the product or any similar one'. Univariate and multivariate multinomial logistic regression models were used to explore the influence of individual variables on participants' likelihood of having taken different decisions when facing a product with warnings. Results showed that participants older than 55 years were more likely to react to the warnings by purchasing a similar product with fewer warnings or by not purchasing any product. Likelihood of modifying purchase decisions due to the inclusion of the warnings was associated with a frequent consumption of natural and minimally processed foods and a low consumption frequency of ultra-processed products. These results provide insights to target efforts to promote the use of nutritional warnings in decision making.

RESUMEN El objetivo del presente trabajo fue explorar la influencia de caraterísticas de los consumidores en sus decisiones de compra al enfrentar productos con advertencias nutricionales, unos días después de su implementación en Uruguay. Se obtuvo una muestra no probabilística de 917 participantes utilizando redes sociales. Se les preguntó a los participantes si habían visto las advertencias en un producto que tenían la intención de comprar. A los participantes que respondieron afirmativamente (n= 616) se les pidió qué indicarn qué habían hecho con el producto, utilizando las siguientes opciones de respuesta: 'Lo compré igual', 'Compré un producto similar con menos símbolos de exceso', 'Compré un producto similar sín símbolos de exceso' y 'No compré el producto ni tampoco otro similar. Los datos se analizaron utilizaron modelos de regresión multinomial univariados y multivariados. Los participantes mayores de 55 años presentaron una mayor probabilidad de reaccionar a las advertencias no comprando el producto. La probabilidad de modificar la decisión de compra debido a las advertencias estuvo asociada con una mayor frecuencia de consumo de alimentos naturales y mínimamente procesados y una menor frecuencia de consumo de productos ultra-procesados. Los resultados del presente trabajo sugieren que los esfuerzos para promover el uso de las advertencias en la toma de decisiones deben estar focalizados en los ciudadanos con el mayor consumo de productos ultra-procesados.

Analysis of the policy process for the implementation of nutritional warning labels in Uruguay.

OBJECTIVE: To analyse the process for the development and implementation of mandatory nutritional warning labels in Uruguay, in order to inform future nutrition policy making and strategic engagement by public health actors. DESIGN: The study design drew on policy analysis methodology and case study research methodology. Two main sources of information were selected and analysed for the current study: eighteen official documents from the Uruguayan government and 259 news reports, published between June 2017 and February 2021. SETTING: Uruguay, Latin America. RESULTS: The Uruguayan Ministry of Public Health led a cross-sectoral working group composed of diverse governmental stakeholders, international organisations and the academia to develop the front-of-package nutrition labelling policy. A robust evidence-based approach, based on rigorous scientific knowledge generated in the country, was followed. However, changes in the systemic governing coalition as a consequence of a change in government led to a delay in the entry into force and changes in the regulation. The food industry was the main opponent to the warning label regulation and relied on widely reported corporate political activities to influence the policy process: information and messaging, legal action, policy substitution, opposition, fragmentation and destabilisation. CONCLUSIONS: Key insights to inform future policy action in Uruguay and other jurisdictions were derived. Results stressed the importance of an evidence-based approach for policy design and the early engagement with actors from all the political system.

Health gains through loss frames: Testing the effectiveness of message framing on citizens' use of nutritional warnings.

The aim of the present work was twofold: (i) to evaluate the effect of nutritional warnings and health-related packaging cues (nutrient claim and images of natural foods) on consumers' food choices, and (ii) to evaluate the influence of two types of messages (gain-framed and loss-framed) aimed at encouraging the use of such warnings and packaging cues on food choices. A total of 510 participants were recruited using an advertisement on Facebook and Instagram targeted at Uruguayan adult users. Participants were randomly allocated to one of three experimental groups: control (n = 167), loss-framed messages (n = 177) and gain-framed messages (n = 166). Then, they completed a choice-conjoint task involving packages of crackers differing in three variables: nutritional warnings (present vs. absent), nutrient claim (present vs. absent) and images of seeds and wheat (present vs. absent). Warnings were the most relevant package element driving choices, even when participants were not exposed to any type of message. Exposure to loss-framed messages led to changes in the relative importance attached to the package characteristics, whereas gain-framed messages did not. Graphic pieces conveying messages encouraging the use of nutritional warnings by stressing the negative consequences of excessive consumption of sugar, fat, and sodium increased the relative importance attached to nutritional warnings and decreased the relative importance attached to health-related cues (nutrient claims and images of seeds and wheat). These results suggest that public awareness campaigns aimed at encouraging citizens to use nutritional warnings should emphasize the negative health consequences of excessive intake of sugar, fat, and sodium.

Listening to the voices of adolescents for the design of strategies to promote healthy eating: an exploratory study in a Latin American country.

OBJECTIVE: To explore adolescents' views about the foods they consume and to identify their ideas about strategies to encourage healthier eating habits. DESIGN: Individual questionnaires based on open-ended questions and group discussions (6-8 participants) were used to address the objectives. Data were analysed using content analysis based on deductive-inductive coding. SETTING: Montevideo and its metropolitan area (Uruguay, Latin America). PARTICIPANTS: Totally, 102 adolescents (aged between 11 and 15 years, 52 % female) recruited at two educational institutions. RESULTS: Adolescents reported frequently consuming ultra-processed products and fast food although they were perceived as bad for their health, whereas they reported an infrequent consumption of fruits and vegetables. Multifaceted strategies to promote healthy eating habits emerged from adolescents' accounts, including public awareness campaigns, nutrition education programmes, nutrition label standards and regulations, and changes in food availability and affordability. CONCLUSIONS: Results from the present work suggest that co-creation with adolescents may be an effective way to inform the development of strategies to promote healthier eating habits. The strategies suggested by adolescents were mainly focused on behaviour change communication, who emphasised the importance of social media and the involvement of celebrities and influencers. The need for educational and communication strategies to raise awareness of the social and environmental drivers of eating patterns among adolescents was identified.

COVID-washing of ultra-processed products: the content of digital marketing on Facebook during the COVID-19 pandemic in Uruguay.

OBJECTIVE: To explore the use of references to the COVID-19 pandemic as part of the marketing strategies used on Facebook to promote ultra-processed products. DESIGN: A search for Facebook accounts of ultra-processed products was performed using a master list of products commercialised in two online supermarkets in Uruguay. For each of the identified Facebook accounts, all the content posted from the confirmation of the first cases of COVID-19 in Uruguay, on 14 March 2020, until 1 July 2020 was recorded. Posts including mentions to COVID-19, social distancing measures or their consequences were identified and analysed using content analysis. SETTING: Uruguay, Latin America. RESULTS: A total of 135 Facebook accounts were identified, which generated a total of 1749 posts related to ultra-processed products, from which 35 % included references to COVID-19. The majority of the posts included references to prevention measures. Approximately one-third of the posts included proposals of activities to do at home, most of which were linked to a healthy lifestyle. Tips for coping with quarantine and descriptions of the charitable work undertaken by brands were also identified. CONCLUSIONS: Results from the present work provide evidence that industries of ultra-processed products have taken advantage of the COVID-19 pandemic to promote their products, create positive associations with the brands and improve their image as part of their digital marketing strategies.

Are the recommendations of paediatricians about complementary feeding aligned with current guidelines in Uruguay?

OBJECTIVE: To explore Uruguayan paediatricians' personal recommendations about complementary feeding and to assess if they are aligned with current guidelines and scientific evidence. DESIGN: A questionnaire composed of open-ended questions was used to explore foods recommended to start complementary feeding, foods regarded as the most important during the first meals, recommendations for delayed introduction of foods and foods that should be avoided. Reasons underlying the recommendations were also explored. SETTING: Montevideo, the capital city of Uruguay (Latin America). PARTICIPANTS: A total of 212 paediatricians were recruited during a National Pediatrics Conference, organised by the Uruguayan Society of Pediatrics. RESULTS: The recommendations about complementary feeding provided by paediatricians to parents and caregivers in Uruguay seemed not to be fully aligned with the guidelines provided by the Ministry of Health. Paediatricians recommend a rigid food introduction sequence, characterised by the early introduction of soft pureed vegetables and fruits, followed by meat and the delayed introduction of allergenic foods. Food diversity and the concept of ultra-processed were not frequently identified in the responses. CONCLUSIONS: Results stress the importance of developing educational and communication approaches targeted at paediatricians to contribute to the uptake of updated recommendations regarding complementary feeding.

Immediate effects of the implementation of nutritional warnings in Uruguay: awareness, self-reported use and increased understanding.

OBJECTIVE: To assess the effects of nutritional warnings during the first month after the date of full compliance by the food industry in Uruguay in terms of citizen awareness, self-reported use and ability to understand nutritional information. DESIGN: The present work encompassed two online studies, conducted before (Study 1) and during the first month after the date of full compliance by the food industry (Study 2). An after-only design was used to assess awareness of the policy, exposure to nutritional warnings on food packages and self-reported use of warnings for making purchase decisions in Study 2. An after-only with control group experimental design was used to assess the effect of nutritional warnings on understanding of nutrition information in Studies 1 and 2. SETTING: Uruguay, one of the Latin American countries, that has recently implemented nutritional warnings. PARTICIPANTS: A non-probabilistic sample of 1772 participants was recruited using Facebook advertisements targeted at Uruguayan adult users. RESULTS: High awareness and self-reported use of nutritional warnings during the first month after the date of full compliance in Uruguay were observed. In addition, the before and after comparison showed that the implementation of warnings increased citizens' ability to use nutritional information to compare products and to identify products with excessive content of sugar, fat, saturated fat and sodium. CONCLUSIONS: The current study confirms results from experimental studies and provides additional evidence to support the implementation of nutritional warnings as one of the public policies that can contribute to tackle obesity and non-communicable diseases.

The idealisation of bottle feeding: content analysis of feeding bottles and teats packages in Uruguay.

OBJECTIVE: The information displayed on the packages of feeding bottles and teats commercialised in Montevideo (Uruguay) was analysed using content analysis with the goal of identifying key marketing practices that may discourage breast-feeding. DESIGN: The study was conducted as part of the periodic assessment performed by the Uruguayan government to monitor the marketing of breast milk substitutes. All the feeding bottles and teats sold in forty-four retail outlets selling breast milk substitutes were purchased. The information available on the packages was analysed using content analysis and descriptive statistics. SETTING: Montevideo, Uruguay. RESULTS: A total of 197 feeding bottles and 71 teats were found. The majority of the packages included information to enable caregivers to adequately use the products, including recommended age, instructions on how to use the products and instructions on the use of hygienic practices. However, the packages frequently included information that implied that bottle feeding was equivalent to breast-feeding, particularly from a physiological perspective, or that idealised product use. Idealisations included ability to reduce colic, improvements in the feeding experience and improvements in children's health, well-being and development. Statements on the superiority of breast-feeding were infrequent. CONCLUSIONS: The results from the present work showed the high prevalence of marketing practices on the packages of feeding bottles and teats that may discourage breast-feeding. Stricter and more detailed regulations seem necessary to enable caregivers to make informed feeding decisions for infants.