Dimensions of food-related wellbeing and their relative importance among New Zealand consumers: A quasi-replication and extension approach.

Research into perceived wellbeing (WB) can improve understanding of consumer food choices and support development of strategies to promote healthier and more sustainable eating habits. In this research, using online studies, food-related WB was explored among New Zealand consumers. In a "quasi-replication" of Jaeger, Vidal, Chheang, and Ares (2022), Study 1 uncovered word associations to different WB-related terms ('Sense of wellbeing,' 'Lack of wellbeing,' 'Feeling good,' 'Feeling bad/unhappy,' 'Satisfied with life,' and 'Dissatisfied with life') with 912 participants in a between-subjects design. The results confirmed the multidimensional nature of WB, and the need to consider positive and negative aspects of food-related WB, as well as differences linked to physical, emotional, and spiritual WB. Drawing on Study 1, 13 characteristics of food-related WB were identified, and in Study 2 their importance for feeling a 'Sense of wellbeing' and 'Satisfied with life' was determined with 1206 participants using a between-subjects design. In a further extension, Study 2 also adopted a product-specific perspective and explored the associations of, and importance, for 16 different foods and beverages to food-related WB. Based on Best-Worst Scaling and penalty/lift analysis, the four most important characteristics overall were 'Is good quality,' 'Is healthy,' 'Is fresh,' and 'Is tasty,' with the nuance that healthiness contributed most to feeling a 'Sense of wellbeing' while good quality contributed most to feeling 'Satisfied with life.' The associations to individual foods and beverages underscored that food-related WB is a complex construct arising from an overall evaluation of the different effects of foods (including physical health, social and spiritual aspects of food consumption) and their short-term effects on food-related behaviour. Contextual and individual differences in perceptions of WB in relation to food deserve further investigation.

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.

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.

Parenthood as a Window of Opportunity for Dietary Changes: Perspectives From Uruguayan Parents.

Research on behavioral and social science has demonstrated that transitions throughout a person's life course, as the life event of becoming a parent, represent an opportunity for dietary changes. However, research in this area has been mostly restricted to developed European and North American countries and has shown ambiguous results. The present work aimed to gain an in-depth understanding on the changes in eating habits caused by the transition to parenthood and to explore factors influencing those changes in Uruguay, a Latin American country. Forty-two in-depth interviews with Uruguayan parents from diverse social-economic backgrounds were conducted. The narrations by the interviewees evidenced mostly positive changes during three stages in the transition: pregnancy, the first months with the baby, and the beginning of complementary feeding. Most informants perceived changes mainly in terms of increased consumption of fruits, vegetables, and pulses; increased consumption of homemade meals; and decreased consumption of ultra-processed foods, fast foods, and fried foods. Reasons for these changes included adaptation of meals to the child's needs and schedule, feeling of responsibility for the child's health, and willingness to be a good role model. Factors influencing changes in eating habits were identified in some levels of the socioecological model and included socioeconomic status; price of fruits, vegetables, and fish; low accessibility of good quality fish; perceived time pressure; father's low interest on healthy eating; social support; and access to nutrition information. Findings suggest that parenthood represents a window of opportunity for favorable changes in eating habits. However, barriers constraining those changes should be addressed by stakeholders.

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.

Consumer conceptualisations of food-related wellbeing: An exploration of wellbeing-related terms in four industrialised countries.

Perceived (or subjective) wellbeing is regarded as key to understanding consumer food choices and the development of strategies to promote desirable eating habits. Yet, in-depth understanding of the specific factors that contribute to people's perceived wellbeing across cultures is lacking. These factors motivated the present research that used word associations to conduct an exploratory analysis of consumer conceptualisations of food-related wellbeing (WB). Adults (n = 4945) living in the United Kingdom, Australia, Singapore or Germany, and speaking respectively, English or German, took part in the study. Health, pleasure, food quality, positive emotions and social aspects of food consumption were the main associations with food-related wellbeing. Absence hereof was associated with unhealthiness, disgust, negative emotions and poor mental health. The differences in these main associations emphasised the importance of exploring wellbeing, as well as lack hereof. Not doing so leads to an incomplete understanding of this multidimensional construct. The research was conducted with four terms related to wellbeing (each in their positive and negative versions): 'sense of wellbeing' and 'lack of wellbeing', 'feeling good' and 'feeling bad/unhappy', 'satisfied with life' and 'dissatisfied with life' and 'fulfilled in life' and 'unfulfilled in life'. Because these different terms gave rise to different wellbeing associations, researchers in this area must choose their empirical approach with care. The terms 'sense of wellbeing' and 'feeling good' tended to more frequently give rise to health-related associations. Conversely, 'satisfied with life' and 'fulfilled in life' tended to more frequently give rise to positive spiritual and emotional associations of food-related wellbeing. The main conceptualisations of food-related wellbeing were cross-culturally similar, but extension of the present research to other Asian countries was recommended based on several differences between Singaporean participants and those from other countries. In ethnically diverse countries like Singapore, further within-country investigations of different cultures will also have merit.

A Qualitative Exploration of Parents' Food Choices During Early Childhood.

OBJECTIVE: To explore parents' accounts of the goals they seek when choosing foods for their young children through the lens of goal-systems theory. DESIGN: In-depth interviews with parents of children aged from 6 months to 5 years. SETTING: Montevideo, Uruguay. PARTICIPANTS: Forty-two parents (aged 19-44 years, 90% female). PHENOMENON OF INTEREST: Parents' personal experiences, feelings, and opinions related to how they choose foods for their children. ANALYSIS: Content analysis based on deductive-inductive coding. RESULTS: Parents' accounts confirmed they intended to pursue different goals when choosing foods for their children. Health-related goals mainly motivated the selection of healthy foods, but they also drove the selection of some ultra-processed products because of misconceptions about their healthiness. Pleasure and enjoyment motivated the selection of ultra-processed products, whereas stress avoidance was associated with selecting convenient foods. The selection of unhealthy foods raised conflicts between goals, which were solved using goal shielding, changes in risk perception and/or compensatory health beliefs. CONCLUSIONS AND IMPLICATIONS: Results point to the need for communication campaigns and community-based interventions to introduce changes in how ultra-processed products are conceptualized and increase the associations between healthy foods and children's pleasure and enjoyment to promote healthier eating patterns during infancy and early childhood.

'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.

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.

Is COVID-19 a threat or an opportunity for healthy eating? An exploration of the factors that moderate the impact of the pandemic on eating habits in Uruguay.

In May 2020, Uruguay was one of the few Latin American countries that had managed to control the outbreak of COVID-19 without mandatory curfews or quarantines. However, several social distancing measures created a major disruption in different aspects of the daily life of Uruguayan citizens. In this context, the objectives of the present work were i) to identify changes in eating habits perceived by Uruguayan citizens as a consequence of the COVID-19 pandemic, and ii) to explore factors associated with different perceived changes on eating habits. A cross-sectional online study was conducted with 891 participants, recruited using an advertisement on Facebook and Instagram. Fifty-one percent of the participants indicated that their eating habits had changed since the detection of the first cases of COVID-19 in Uruguay. Large heterogeneity in the categorization of the changes existed: 45% of the participants regarded the changes as positive, 32% as negative and 23% as neither positive nor negative. A multinomial logistic regression analysis was used to study the influence of explanatory variables in the likelihood of belonging to groups who reported different changes in eating habits (no changes, positive, negative, or neither positive nor negative changes). Household income and reliance on instrumental and emotional support increased the likelihood of reporting positive changes in eating habits, whereas negative changes were associated with a reduction in household income due to COVID-19 and the coping strategies self-distraction and self-blaming. Insights for policy making to reinforce positive effects and minimize threats to healthy eating are discussed.

Marketing of commercial foods for infant and young children in Uruguay: sugary products, health cues on packages and fun social products on Facebook.

OBJECTIVE: To analyse the content of the marketing of commercial foods for infants and young children on packages and social media. DESIGN: Commercial foods targeted at children, regarded as potential breast-milk substitutes according to the Uruguayan breast-feeding standard, were considered: dairy products; teas, juices and bottled waters; glucose solutions; cereals and mixtures of fruits and vegetables. All the products sold at forty-four retail outlets were purchased. A Facebook search was performed to identify accounts of these products. For each account, all the content posted by the brands between July 2017 and July 2019 was recorded. The visual and textual information included in the packages and Facebook posts was analysed using content analysis. Products were classified using the nutrient profile model of the Pan American Health Organization. SETTING: Montevideo, Uruguay. RESULTS: Seventy-six unique commercial foods targeted at infants and young children were identified, 96 % of which were excessive in sugar. Packages frequently included textual and visual elements to convey health-related associations, including images of fruits and vegetables, nutrient content claims and endorsement logos. Ten Facebook accounts were identified, which generated 302 posts. Parents and caregivers were the main target audience of the posts, which mainly included content related to fun and social aspects of food consumption. Additionally, the posts frequently conveyed the idea that products would contribute to children's growth and development. CONCLUSIONS: Results suggest the need to implement comprehensive regulations on the marketing of commercial foods targeted at children, regarded as potential breast-milk substitutes according to the Uruguayan breast-feeding standard.

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.

The social representations of complementary feeding.

The social representations of complementary feeding are expected to shape parents' decisions and to provide justification or legitimization for their practices. The aims of the present work were: i) to explore the social representations of complementary feeding in parents and health professionals, ii) to evaluate if the onset of complementary feeding modify social representations in parents, and iii) to compare the representations of parents and pediatricians. Three groups of participants were considered: 170 parents of children who had not started complementary feeding (1-4 months old), 170 parents of children who had started complementary feeding (7-10 months old) and 212 pediatricians. Parents were recruited in health facilities in Montevideo (Uruguay), whereas pediatricians were recruited at the National Pediatrics Conference. Participants were asked to complete a word association task with "the first meals of a baby". All the responses provided by participants were grouped into categories using content analysis. The structure of the social representations was assessed considering the frequency of mention and the average rank of appearance of the categories. Results showed that the social representations of complementary feeding for both parents and pediatricians were extremely narrow and mainly focused on specific foods: puree and a small set of vegetables and fruits. None of the categories showed high frequency of mention and low rank of appearance, indicating that the structure of the social representations did not include any element in the first periphery. According to the theory of social representations, results from the present work suggest that the social representations of complementary feeding for Uruguayan parents and pediatricians are deeply rooted and resistant to change.

Communication Campaigns to Support the Use of Nutritional Warnings: Different Messages for Different People?

Communication campaigns are expected to contribute to increase the efficacy of nutritional warnings. In this context, the aims of the present work were (a) to evaluate how citizens perceive different types of messages for a communication campaign and (b) to determine if personal characteristics such as gender, age, and educational level, as well socioeconomic and nutritional status, moderate how citizens perceive such campaign messages. A series of graphic pieces were designed for each of the following three types of messages: promotion of informed food choices; raising awareness of the negative health consequences of excessive consumption of sugar, fat, and sodium; and promotion of healthy food choices. An online study was conducted with 774 participants, who were randomly assigned to one of the three types of messages. The participants' self-reported perception of the graphic pieces was evaluated using 7-point Likert-type scales. After completing the evaluation task, the participants proceeded to a series of choices. This was implemented to evaluate whether exposure to different types of messages affected hypothetical food choices. Results revealed that messages related to the promotion of healthy eating were perceived as the most adequate as part of a communication campaign and had the potential to encourage more healthful hypothetical choices in the experimental task. However, gender, age, and nutritional status moderated the influence of the type of message on the participants' perception, meaning that different groups perceived different types of messages as the most adequate. The results from the present work stress the need to include different types of messages in a communication campaign to target individuals with different motivations and characteristics.

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.

The experience of social distancing for families with children and adolescents during the coronavirus (COVID-19) pandemic in Uruguay: Difficulties and opportunities.

The social distancing measures implemented to contain the coronavirus (COVID-19) pandemic worldwide have created a series of emotional and economic challenges. The aim of the present work was to explore the experiences of families with children and adolescents during the coronavirus (COVID-19) pandemic in Uruguay. An online study was conducted in March 2020 with 1725 parents with children under 18 years old. A series of closed and open-ended questions about their family life since the implementation of social distancing measures were asked, addressing the following topics: how they had felt, changes they had experienced in their daily life, children's daily routine, changes implemented in relation to child-care, changes they had perceived in children's eating patterns, changes in their relationship with their children, changes in their children's mood and behavior, and their reaction to those changes. Results showed that the coronavirus pandemic elicited negative feelings in the majority of participants, mainly related to worry, fear, anxiety and uncertainty. Social distancing measures caused a major disruption in daily habits, which were mostly attributed to changes in work-related activities and the closure of educational institutions. Changes in children's mood and behavior were perceived by the majority of the participants, who mainly referred to boredom, agitation and restlessness. Although some participants reported difficulties to cope with children's behavior during social distancing, others valued the opportunity of spending more time with their children. In terms of children's eating patterns, changes related to both an increase and a decrease in the consumption of healthy foods were observed. Results from the present work have relevant implications for public health policy and practice by highlighting the importance of providing emotional and psychological support to people during social distancing measures and providing insights for the design of communication campaigns and interventions.

Healthier eating: Covid-19 disruption as a catalyst for positive change.

Healthy and sustainable diets are necessary for global development goals, but people struggle to modify their eating behaviours which are often habitual and resistant to change. However, disruption can provide the impetus for change, and in the present research we view the Covid-19 pandemic as a potential catalytic disruption with the potential to induce positive behaviour change. Data were obtained from ~900 USA adults, of which 44% self-reported to have made positive dietary change/s. Those who did so tended to be younger rather than older and with higher educational attainment. They also were less food neophobic than people who did not make positive change/s and placed greater importance on health as a motive of daily decisions about what to eat and drink. The contribution of psychographic variables in differentiating between groups of people who did / did not make positive changes once again show their importance in uncovering and explaining the complex factors that motivate food-related consumer behaviour. It seems this holds also when daily lives are disrupted by unforeseen events.

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.

Uruguayan Citizens' Perception of Messages to Promote Healthy Eating Through the Use of Nutritional Warnings.

OBJECTIVE: To explore the specific type of messages people consider most appropriate for a mass communication campaign aimed to promote healthy eating in the context of the implementation of nutritional warnings. DESIGN: Online study including multiple-choice and open-ended questions. SETTING: Uruguay, 1 of the Latin American countries with the highest prevalence of overweight and obesity. PARTICIPANTS: A total of 859 participants were recruited using social media. They were diverse in terms of gender, age, educational level, socioeconomic status, and self-reported body mass index. PHENOMENON OF INTEREST: Participants were presented with 3 series of messages and were asked to select the 1 they perceived as the most appropriate and to provide a brief explanation for their selection. ANALYSIS: Descriptive statistics for the multiple-choice questions and inductive coding for the responses to the open-ended questions. RESULTS: Participants tended to prefer messages that conveyed a cue to action for achieving changes to their perceived ability to make healthful food choices. Although messages related to the promotion of informed food choices were the most frequently preferred, messages related to negative health consequences and health benefits were also selected repetitively. CONCLUSIONS AND IMPLICATIONS: Communication campaigns aimed at promoting healthy eating through the use of nutritional warnings could include different contents to target specific segments with different motivations.

Social representations of breastfeeding and infant formula: An exploratory study with mothers and health professionals to inform policy making.

Although several efforts to promote breastfeeding have been implemented worldwide, the prevalence of exclusive breastfeeding in the first 6 months of life remains low. One of the factors responsible for this trend is the widespread sales and marketing of breast-milk substitutes. In this context, the present work aimed at exploring mothers and health professionals' social representations of breastfeeding and infant formula. The study was conducted in Montevideo (Uruguay), as part of the periodic assessment performed by the Uruguayan government to monitor the marketing of breast-milk substitutes according to the OMS/UNICEF NetCode toolkit. A total of 330 mothers of children under 24 months old and 154 health professionals were recruited at 33 health care facilities. Participants were asked to complete two word association tasks, one with breastfeeding and the other with infant formula. Inductive coding was used to classify the responses into categories and dimensions. The structure of the social representations was explored considering the frequency of mention and the average rank of appearance of the categories. Results showed that mothers' social representations mainly positioned breastfeeding as a feeding practice, whereas infant formulas were mainly perceived as a complement to breast-milk that provides support. In the case of health professionals, the social representations of breastfeeding and infant formulas were in line with scientific evidence and health recommendations. These results suggest that efforts to promote breastfeeding should focus on raising public awareness of the risks associated with breast-milk substitutes and on overcoming the systemic barriers to breastfeeding, particularly among working mothers.