Self-reported reactions to the front-of-package warning labelling in Mexico among parents of school-aged children

Background To improve the food environment and guide consumers to select healthier foods, the implementation of a front of package warning labelling (FOPWL) started in Mexico in October 2020. We aimed to identify the self-reported support, understanding, use and perceived impact of the FOPWL 1-5 months after its implementation among parents of school-aged children across socioeconomic categories and nutrition knowledge and attitudes. Methods EPHA-niñ@s is a national web-based cohort of Mexican children 5-10 y and one of their parents aiming to monitor their food and food policy perception and opinions and children’s dietary intake. Recruitment was conducted primarily through paid advertisements on social media. Data was collected online with a self-administered questionnaire answered by the parent and an interviewer-administered questionnaire answered by the child during a video call. This analysis was conducted with data from the parent’s questionnaire from the first wave of data collection (November 2020-March 2021) which included 2,071 participants from all over the country. We evaluated differences by socioeconomic status (SES), education and nutrition knowledge and consciousness, while adjusting by other sociodemographic characteristics using multinomial logistic regression. Results The sample was predominantly from middle and high socioeconomic status (SES). Most parents (85%) agree/strongly agree with the FOPWL (support), 86% correctly identified that a product with one warning is healthier than a product with three (understanding), 65% compared the number of warnings sometimes to very often (use), and 63% reported buying less and 25% stopped buying products with warnings for their children (perceived impact). The perceived impact was higher when products were for their children than for themselves. Perceived impact also differed by food group, being higher for sodas, juices, and cereal bars and lower for chips and chocolate powder. Responses were more favorable for five-six questions (out of seven) among those with higher nutrition knowledge, and higher nutrition consciousness, and for three questions among those with higher education level. Conclusion Within six months of implementation, the immediate self-reported responses related to support, understanding, use, and perceived impact to the Mexican FOPWL were favorable. Further studies in other populations including low SES participants and impact evaluations, are needed. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by Bloomberg Philanthropies. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The survey protocol was reviewed and approved by the Research and Ethics Committees of the Mexican National Institute of Public Health. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors