Who is missing the message? Targeting strategies to increase food label use among US adults

Objective: To evaluate the associations between sociodemographic and psychosocial characteristics and food label (FL) use in US adults. Design: Data from the 1994-1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey were used. High socio-economic status (SES) was defined as >high school education and poverty-income ratio (PIR) <350%, low SES as, <high school level or PIR <130%. Dietary intakes were assessed using 24 h recalls. Setting: Metropolitan statistical area-central city, -suburban, and rural areas in the USA. Subjects: US adults (n 2797; 1460 men, 1337 women) aged 20-64 years. Results: Approximately 80% of Americans reported using FL, including checking the nutrition panel, list of ingredients, short phrases, serving size, or health benefits. Only 26% used all FL information. Compared with white women of higher SES, white men, black men and women with lower SES were 77-90% less likely to use FL. Rural residents were 40% less likely (OR =0.60; 95% CI 0.42, 0.86). Participants with good nutrition knowledge, perceptions and beliefs were twice as likely to check FL for nutrient content of foods (OR+2.28; 95% CI 1.53-3.40). Those who were unaware of diet-disease relationships were less likely to use FL (OR=0.53; 95% CI 0.32-0.85). Among overweight/obese Americans (BMI >= 25 kg/m(2)), those who perceived their weight 'about right' were 51% less likely to use FL than those perceiving themselves as overweight. Conclusions: Men, especially black men, women of low SES, rural residents and overweight Americans with inaccurate self-perception of body weight are less likely to use FL and should be targeted for increased intervention.