OUP accepted manuscript

Nutrition labels on pre-packaged foods are an important source of nutrition information; however, differences in comprehension of varying label formats may limit their use and effectiveness.This study examined levels and correlates of consumers' self-reported understanding of Nutrition Facts tables (NFt) and Front-of-Package (FOP) labels, as well as functional NFt understanding.Adults (≥18 years) in Australia (n = 3901), Canada (n = 4107), Mexico (n = 4012), United Kingdom (UK) (n = 5121), and the United States (US) (n = 4445) completed online surveys in November-December 2018. Descriptive statistics summarized sample profiles by country. Linear regression models examined the association between label understanding (self-reported NFt and FOP, functional NFt) and consumer dietary behaviours, functional nutrition knowledge, and sociodemographic characteristics. NFt understanding was measured in all countries, with FOP labelling assessed only in Mexico, Australia, and the UK.Self-reported and functional NFt understanding was significantly higher in the US and Canada (P < 0.0001). In adjusted analyses, functional NFt understanding was significantly higher among women than men (P < 0.0001); respondents from the 'majority' ethnic group in their respective countries compared to minority ethnic groups (P < 0.0001); those with higher education levels (P < 0.0001) and functional nutrition knowledge compared to their lower education and nutrition knowledge counterparts (P < 0.0001), respectively; and those making efforts to consume less sodium, sugar or fat compared to those not reporting dietary efforts (P < 0.0001). Self-reported FOP label understanding was significantly higher for interpretive labelling systems in Australia (Health Star Ratings) and the UK (Traffic Lights) compared with Mexico's Guideline Daily Amounts (GDA) (P < 0.0001).Nutrition labels requiring greater numeracy skills (i.e., NFt, GDA) were more difficult for consumers to understand than interpretive FOP labels (i.e., Traffic Lights). Differences in NFt and FOP label understanding by income adequacy and education suggest potential disparities in labelling policy effects among vulnerable subgroups.