Christine White | University of Waterloo, Canada (original) (raw)

Papers by Christine White

Preventive Medicine Reports, 2021

Front-of-package (FOP) nutrition labels have been proposed as a strategy to help limit sugar-swee... more Front-of-package (FOP) nutrition labels have been proposed as a strategy to help limit sugar-sweetened beverage (SSB) consumption among youth. However, few studies have examined the efficacy of FOP labels in youth across different countries. A between-group experiment was conducted to examine the impact of FOP labels (no-label control, Health Star Rating, 'High in' Octagon, Guideline Daily Amount (GDA), Traffic Light, or Nutri-Score) on perceived healthfulness of an SSB. The study was conducted online in November-December 2019 with 10,762 children aged 10-17 from six countries: Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. A binary logistic regression model tested the impacts of FOP label condition, country, and sociodemographic characteristics on participants' likelihood of perceiving the SSB to be Unhealthy. Compared to the control condition, participants in each of the five FOP label conditions were significantly more likely to perceive the SSB as Unhealthy (p < 0.002). The 'High in' Octagon label had the greatest impact on perceived healthfulness across five out of six countries, whereas the GDA and Nutri-Score labels demonstrated the lowest impact across all six countries. The impact of FOP labels was consistent across sex, age, race/ethnicity, and perceived income adequacy. FOP labels can significantly reduce the perceived healthfulness of SSBs among youth across multiple countries. The current study adds to the evidence that 'high in' labels, which use intuitive symbols such as the octagon 'stop sign', are the most efficacious labels for helping consumers identify foods high in nutrients of concern, including SSBs.

International Journal of Environmental Research and Public Health, 2020

Online food delivery services like Just Eat and Grubhub facilitate online ordering and home deliv... more Online food delivery services like Just Eat and Grubhub facilitate online ordering and home delivery of food prepared away-from-home. It is poorly understood how these services are used and by whom. This study investigated the prevalence of online food delivery service use and sociodemographic characteristics of customers, in and across Australia, Canada, Mexico, the UK, and the USA. We analyzed online survey data (n = 19,378) from the International Food Policy Study, conducted in 2018. We identified respondents who reported any online food delivery service use in the past 7 days and calculated the frequency of use and number of meals ordered. We investigated whether odds of any online food delivery service use in the past 7 days differed by sociodemographic characteristics using adjusted logistic regression. Overall, 15% of respondents (n = 2929) reported online food delivery service use, with the greatest prevalence amongst respondents in Mexico (n = 839 (26%)). Online food delive...

Preventive Medicine, 2018

In 2017, Ontario became the first Canadian province to require calorie amounts on menus/menu boar... more In 2017, Ontario became the first Canadian province to require calorie amounts on menus/menu boards of chain restaurants. The province of British Columbia (BC) implemented a voluntary nutrition information initiative in which calorie and sodium information were available upon request. A quasi-experimental design was used to examine the use of nutrition information in Ontario (mandatory calorie labelling), compared to BC (voluntary policy) and three other provinces with no formal menu labelling policy ('control'). Data were collected from youth and young adults (16-30 years) in all provinces pre-(fall 2016; n=2,929) and post-(fall 2017; n=968) implementation of Ontario's calorie-labelling policy in January 2017. Generalized estimating equations tested differences between provinces over time in noticing and impact of nutrition information and support of mandatory calorie labelling. Noticing of nutrition information in restaurants increased in Ontario significantly more than in BC (+25.1% vs. +1.6%; AOR=4.26, 95% CI= 2.39-7.61) and control provinces (+6.5%; AOR=3.00, 95% CI=1.91-4.73). Ontario respondents were significantly more likely to report that the nutrition information influenced their order than those in BC (+12.9% vs. +2.2%; AOR=3.53, 95%CI=1.61-7.76) and control provinces (+2.0%; AOR=3.71, 95%CI=1.87-7.36). Policy support increased in all groups at follow-up, with a significantly greater increase in Ontario than control provinces (+12.9% vs. +5.7%; AOR=1.57, 95%CI=1.06-2.34). Socio-demographic differences were also observed. Findings suggest that the mandatory menu labelling policy implemented in Ontario has increased noticing and use of nutrition information, with no evidence to support the effectiveness of voluntary policies that require consumers to request nutrition information.

Nutrition journal, 2018

The contribution of beverages to overall diet is of increasing interest to researchers and policy... more The contribution of beverages to overall diet is of increasing interest to researchers and policymakers, particularly in terms of consumption of drinks high in added sugars; however, few tools to assess beverage intake have been developed and evaluated. This study aimed to evaluate the relative validity of a new online Beverage Frequency Questionnaire (BFQ) among young adults in Canada. A cross-sectional relative validation study was conducted among young adults aged 16-30 years (n = 50). Participants completed a 17-item BFQ, a 7-day food record (7dFR), and a single-item measure of sugary drink intake. Pearson correlations and paired t-tests were used to evaluate correlation and agreement between the measures for 17 individual beverage categories, total drink consumption, total alcoholic beverage consumption, and two definitions of drinks with excess sugars. Cognitive interviews were conducted to examine participant interpretation and comprehensiveness of the BFQ. Estimates of bever...

Canadian journal of public health = Revue canadienne de sante publique, Jan 7, 2018

Many countries, including Canada, are considering nutrition policies that seek to improve dietary... more Many countries, including Canada, are considering nutrition policies that seek to improve dietary behaviour and related health outcomes. The current study examined support for policy measures among youth and young adults in Canada. Participants aged 16-30 years were recruited for online surveys using in-person intercept sampling in five Canadian cities as part of the Canada Food Study conducted in October-December, 2016 (n = 2729). Items included support for 21 specific policies in seven key areas: menu labelling, food package symbols and warnings, school policies, taxation and subsidies, zoning restrictions, marketing bans, and food formulation. Linear regression models examined support by age, sex, city, race/ethnicity, parental status, body mass index (BMI), and health literacy. Very high levels of support were observed for menu labelling in restaurants and schools, as well as food package symbols and warnings. Taxation, zoning restrictions (e.g., fast food and convenience stores...

Canadian journal of public health = Revue canadienne de sante publique, Jan 29, 2018

To examine food sources among young people in five major Canadian cities. As part of the 2016 Can... more To examine food sources among young people in five major Canadian cities. As part of the 2016 Canada Food Study, respondents aged 16-30 were recruited from five Canadian cities (Toronto, Montreal, Halifax, Edmonton, and Vancouver) using in-person intercept sampling and completed an online survey (n = 2840 retained for analysis). Descriptive statistics were used to summarize food preparation and purchase locations. A linear regression model was fitted to examine correlates of the proportion of meals that were ready-to-eat or prepared outside the home. In total, 80% of meals were prepared at home and 20% were prepared outside the home. More than 25% of meals prepared at home were ready-to-eat/box food. Of all meals consumed, 42% were either ready-to-eat/box food prepared at home or prepared outside the home. Food for meals prepared at home was purchased predominantly at grocery stores/supercentres while meals prepared outside the home were purchased predominantly at fast food/quick se...

The International journal on drug policy, Jan 4, 2018

Although several countries, including Canada, have prohibited the sale of nicotine-containing e-c... more Although several countries, including Canada, have prohibited the sale of nicotine-containing e-cigarettes, there is little evidence examining the impact of such regulatory measures on nicotine content and labelling. E-cigarettes were systematically purchased at 80 retail outlets across 4 cities in Ontario, Canada in January-February 2015. Products' nicotine content and labelling accuracy were assessed using gas chromatography. A total of 166 e-cigarette products were purchased, including disposable products (33%), refillable products (14%), and e-liquids (53%). Similar proportions of products were labelled as 'without nicotine' (41%), and 'with nicotine' (44%), while 15% of products were unlabelled. Analyses revealed that almost half the products (48%) contained nicotine. With respect to the presence of nicotine, 10 products (6%) were mislabelled. Just over one-quarter (27%) of products labelled as 'with nicotine' (n = 73) fell outside their labelled con...

American journal of preventive medicine, Jan 26, 2017

In Canada, energy drinks and energy shots are currently classified and regulated differently (foo... more In Canada, energy drinks and energy shots are currently classified and regulated differently (food and drugs versus natural health products, respectively), on the assumption that they are used and perceived differently. The current study examined potential differences in use and perceptions of energy drinks and shots. An online survey was conducted in 2015 using a national commercial online panel of youth and young adults aged 12-24 years (n=2,040 retained for analysis in 2016). Participants were randomized to view an image of an energy shot or drink, and were asked about 14 potential reasons for using the product. Past consumption of each product was also assessed. Chi-square and t-tests were conducted to examine differences in use and perceptions between products. Overall, 15.6% of respondents reported using both energy shots and drinks. Of all respondents, <1% had tried only energy shots, whereas 58.0% had tried only energy drinks. For each product, the most commonly reported ...

Journal of nutrition education and behavior, Apr 2, 2017

To examine use, knowledge, and perceptions of caffeinated energy drinks (CEDs) among youth. Quali... more To examine use, knowledge, and perceptions of caffeinated energy drinks (CEDs) among youth. Qualitative research using focus group discussions (n = 4). Two Canadian cities (Toronto and Montreal). Youth aged 12-18 years (n = 41). Perceived definitions of CEDs, reasons for use, knowledge of health effects, use with alcohol, marketing perceptions, and use and understanding of cautionary statements on packaging. Data were analyzed using a modified grounded-theory approach. Youth identified CEDs as products that provide energy and contain caffeine and sugar. Compared with mainstream CED brands and energy shots, youth were less likely to perceive Gatorade, Coca-Cola, and a Starbucks beverage as energy drinks, despite some ambiguity. The majority of participants believed that CEDs, including mixed with alcohol, were not necessarily harmful in moderation and that marketing was targeted toward older youth and young adults. Awareness of cautionary statements on CEDs was low; cautionary statem...

Preventive Medicine Reports, 2017

The growing market for caffeinated energy drinks (CEDs) has caused concern about excessive caffei... more The growing market for caffeinated energy drinks (CEDs) has caused concern about excessive caffeine intake and potential adverse effects, particularly among young people. The current study examined patterns of CED consumption among youth and young adults in Canada, using data from a national online survey conducted in October 2014. Data from a non-probability sample of 2040 respondents aged 12-24 from a consumer panel was weighted to national proportions; measures of CED consumption were estimated, including prevalence, excessive daily consumption, and context for use (locations and reasons). Separate logistic regression models for two outcomes, past-week consumption and "ever" exceeding two energy drinks in a day (as per common guidance), were conducted to examine associations with demographic variables (sex, age, geographic region, race/ethnicity, and language). Overall, 73.6% of respondents reported "ever" consuming energy drinks; 15.6% had done so in the past week. Any consumption of energy drinks in the past week was more prevalent among males, Aboriginal respondents (vs. white only or mixed/other), and residents of British Columbia. Among "ever-consumers," 16.0% reported ever consuming more than two energy drinks in a day. Exceeding two in a day was more prevalent among older respondents (young adults aged 18-24), aboriginal respondents (vs. white only), and British Columbia residents. While the majority of youth and young adults had consumed energy drinks, about half were "experimental" consumers (i.e., consumed ≤5 drinks in their lifetime). Approximately one in six consumers had exceeded the usual guidance for maximum daily consumption, potentially increasing their risk of experiencing adverse effects.

Canadian journal of public health = Revue canadienne de sante publique, Jan 20, 2016

Several countries have proposed changes to calorie labelling on nutrition facts tables (NFTs) on ... more Several countries have proposed changes to calorie labelling on nutrition facts tables (NFTs) on pre-packaged foods. As most research to date has examined general use of NFTs, there is a lack of evidence to guide specific design changes to calorie information on labels. This study examined the efficacy of various calorie labelling formats on recall, comprehension, and consumer preferences for calorie information. Experiments were conducted as part of an online survey with a national sample of 2,008 Canadians aged 16-24. In Task 1, participants were shown one of six labelling formats (e.g., %DV, Traffic Light) with calories in either small or large font, and asked to recall the amount of calories. Task 2 examined comprehension of calories in the context of recommended daily intake (RDI), using the same NFT as in Task 1. Task 3 identified participants' preferences for labelling formats. NFTs with calories in large font enhanced calorie recall (p < 0.001). When small font was di...

Preventive Medicine Reports, 2016

Health Check (HC) was a voluntary nutrition labeling program developed by the Heart and Stroke Fo... more Health Check (HC) was a voluntary nutrition labeling program developed by the Heart and Stroke Foundation of Canada as a guide to help consumers choose healthy foods. Items meeting nutrient criteria were identified with a HC symbol. This study examined the impact of the program on differences in consumer awareness and use of nutritional information in restaurants. Exit surveys were conducted with 1126 patrons outside four HC and four comparison restaurants in Ontario, Canada (2013). Surveys assessed participant noticing of nutrition information, influence of nutrition information on menu selection, and nutrient intake. Significantly more patrons at HC restaurants noticed nutrition information than at comparison restaurants (34.2% vs. 28.1%; OR = 1.39; p = 0.019); however, only 5% of HC restaurant patrons recalled seeing the HC symbol. HC restaurant patrons were more likely to say that their order was influenced by nutrition information (10.9% vs. 4.5%; OR = 2.96, p b 0.001); and consumed less saturated fat and carbohydrates, and more protein and fibre (p b 0.05). Approximately 15% of HC restaurant patrons ordered HC approved items; however, only 1% ordered a HC item and mentioned seeing the symbol in the restaurant in an unprompted recall task, and only 4% ordered a HC item and reported seeing the symbol on the item when asked directly. The HC program was associated with greater levels of noticing and influence of nutrition information, and more favourable nutrient intake; however, awareness of the HC program was very low and differences most likely reflect the type of restaurants that "self-selected" into the program.

Public health nutrition, Nov 8, 2016

To test modifications to nutrition label serving size information on understanding of energy (cal... more To test modifications to nutrition label serving size information on understanding of energy (calorie) content among youth and young adults. Participants completed two online experiments. First, participants were randomly assigned to view a beverage nutrition label with a reference amount of per serving (250 ml), per container (473 ml) or a dual-column format with both reference amounts. Participants were then randomized to view a cracker nutrition label which specified a single serving in small font, a single serving in large font, or the number of servings per bag with single serving information below. In both experiments, participants estimated energy content. Logistic regression analysis modelled correct energy estimation. Finally, participants reported their preference for serving size display format. Canada. Canadian youth and young adults (n 2008; aged 16-24 years). In experiment 1, participants randomized to view the nutrition label with per container or dual column were mor...

Health promotion international, Jan 29, 2016

Plain cigarette packaging, which seeks to remove all brand imagery and standardize the shape and ... more Plain cigarette packaging, which seeks to remove all brand imagery and standardize the shape and size of cigarette packs, represents a novel policy measure to reduce the appeal of cigarettes. Plain packaging has been studied primarily in high-income countries like Australia and the UK. It is unknown whether the effects of plain packaging may differ in low-and-middle income countries with a shorter history of tobacco regulation, such as Mexico. An experimental study was conducted in Mexico City to examine perceptions of branded and plain cigarette packaging among smoking and non-smoking Mexican adolescents (n = 359). Respondents were randomly assigned to a branded or plain pack condition and rated 12 cigarette packages for appeal, taste, harm to health and smoker-image traits. As a behavioral measure of appeal, respondents were offered (although not given) four cigarette packs (either branded or plain) and asked to select one to keep. The findings indicated that branded packs were pe...

American journal of preventive medicine, Jan 29, 2015

In 2000, Quebec began reimbursing stop-smoking medications (SSMs) through their provincial public... more In 2000, Quebec began reimbursing stop-smoking medications (SSMs) through their provincial public drug insurance plan. Several other Canadian provinces have since begun offering SSM subsidies. Clinical trials indicate that SSMs can increase quit success; however, little evidence exists on patterns of use in "real-world" settings and impact on population quit rates. This study examines Canadian trends in SSM use and quit success over time, comparing provinces with differing subsidization policies. Secondary analyses were conducted in 2014 using nationally representative Canadian Tobacco Use Monitoring Survey data, 2004-2012, for current and former smokers who made a quit attempt in the past 2 years (N=26,094). Regression models tested for differences in SSM use and quit success in provinces with differing SSM coverage (i.e., none, partial, or comprehensive). Smokers were more likely to use nicotine replacement therapy (NRT) in jurisdictions with comprehensive SSM coverage v...

American Journal of Health Behavior, 2015

Objectives: To examine the impact of a calorie label intervention on cafeteria menus. Methods: Ex... more Objectives: To examine the impact of a calorie label intervention on cafeteria menus. Methods: Exit surveys were conducted in a university cafeteria. Participants were surveyed at baseline and one week after calorie labels were displayed. We assessed changes in noticing and use of nutrition information, the calorie content of food purchased, and estimated calorie consumption. Results: The intervention was associated with significant increases in noticing nutrition information (92.5% vs 39.6%; p < .001), and the use of nutrition information to guide food purchases (28.9% vs 8.8%; p < .001). The calorie content of foods purchased decreased after calorie labels were posted (B =-88.69, p = .013), as did the estimated amount of calories consumed (B =-95.20, p = .006). Conclusions: Findings suggest that displaying calorie amounts on menus can help reduce excess energy intake.

Journal of nutrition education and behavior, 2016

To examine knowledge of recommended daily calorie intake, use of calorie information, and sociode... more To examine knowledge of recommended daily calorie intake, use of calorie information, and sociodemographic correlates between knowledge and use. Population-based, random digit-dialed phone surveys. Canadian adults (n = 1,543) surveyed between October and December, 2012. Knowledge of recommended calorie intake and use of calorie information when purchasing food. Regression models, adjusting for sociodemographics and diet-related measures. Overall, 24% of participants correctly stated their recommended daily calorie intake; the majority (63%) underestimated it, whereas few (4%) overestimated it. Females, younger participants, those with a higher income and more education, and those who consumed fruits and vegetables at least 5 times daily were significantly more likely to state recommended intake correctly. Most respondents (82%) reported considering calories when selecting foods. Respondents considered calories more often if they were female, had a higher income and more education, p...

Canadian Journal of Dietetic Practice and Research, 2016

Limited evidence exists on the comprehension and use of Nutrition Facts tables (NFt) among adoles... more Limited evidence exists on the comprehension and use of Nutrition Facts tables (NFt) among adolescents and young adults. This study provides an account of how young people engage with, understand, and apply nutrition information on the current and modified versions of the NFt to compare and choose foods. Participants aged 16-24 years (n = 26) were asked to &amp;amp;amp;quot;think aloud&amp;amp;amp;quot; while viewing either the current or 1 of 5 modified NFts and completing a behavioural task. The task included a questionnaire with 9 functional items requiring participants to define, compare, interpret, and manipulate serving size and percentage daily value (%DV) information on NFts. Semi-structured interviews were conducted to further probe thought processes and difficulties experienced in completing the task. Equal serving sizes on NFts improved ability to accurately compare nutrition information between products. Most participants could define %DV and believed it can be used to compare foods, yet some confusion persisted when interpreting %DVs and manipulating serving-size information on NFts. Where serving sizes were unequal, mathematical errors were often responsible for incorrect responses. Results reinforce the need for equal serving sizes on NFts of similar products and highlight young Canadians&amp;amp;amp;#39; confusion when using nutrition information on NFts.

Obesity, 2015

To examine knowledge of sugar recommendations and test the efficacy of formats for labeling total... more To examine knowledge of sugar recommendations and test the efficacy of formats for labeling total and added sugar on pre-packaged foods. Online surveys were conducted among 2008 Canadians aged 16-24. Participants were asked to identify recommended limits for total and added sugar consumption. In Experiment 1, participants were randomized to one of six labeling conditions with varying information for total sugar for a high- or low-sugar product and were asked to identify the relative amount of total sugar in the product. In Experiment 2, participants were randomized to one of three labels with different added sugar formats and were asked if the product contained added sugar and the relative amount of added sugar. Few young people correctly identified recommendations for total sugar (5%) or added sugar (7%). In Experiment 1, those who were shown percent daily value information were more likely to correctly identify the relative amount of total sugar (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). In Experiment 2, those shown added sugar information were more likely to correctly identify that the product contained added sugar and the relative amount of added sugar in the product (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Improved labeling may improve consumer understanding of the amount of sugars in food products.