The food nutrition label provides the nutrition information that helps consumers on food choices and used to give us information so that customer can choose between foods. This study was aimed to determine the association between knowledge, attitude and practices on food label use and to determine the factors that influence the use of food labels during making food purchasing decision among university students. A cross-sectional study of undergraduate students at UiTM Puncak Alam in the Kuala Selangor district of Malaysia was conducted in June until July 2011. Three hundred twenty nine students (n = 329) volunteered to complete a Food Label Use Questionnaire (FLUQ) which included question about sociodemographics, level of knowledge about food and nutrition, attitude and practices related to using food labels and factors affecting the use of food labelling. Hypothesis testing was completed using Independent t-test, Pearson chi-square and descriptive analysis in which the statistical significant level was set at α = 0.05. The results show that, only 21.6% of the students often use the food label during food purchasing decision. These study shows that the practices by read the nutrition information were significantly associated with the use of food label (p<0.05). The important aspect during buying food product was expiry date (98.5%), taste (95.7%), price (92.4%) and nutrient content (90.5%) were significantly associated with the use of food label. The students attitude which is do not know how to use nutritional information label (p = 0.028) and label was not attractive (p = 0.037) were significantly associated on food label use.
How to cite this article:
G. Nurliyana, M.N. Norazmir and M.I. Khairil Anuar, 2011. Knowledge, Attitude and Practices of University Students Regarding the Use of Nutritional Information and Food Labels. Asian Journal of Clinical Nutrition, 3: 79-91.
Nowadays, roles of food labels are use to inform the consumer and help sell the food products (Cheftel, 2005). The important of food label was proven when a immune enhancing power bar at present developed in the Vaal University of technology were screened for its nutritional information (Roger et al., 2009). Besides, most of adults consumers are very aware of information on nutrition labels (Fulgoni and Miller, 2006). Other than that, research done by Kretser (2006) found that consumers are attracted in buying healthful foods and beverages from the used of food label to satisfying personal health goals. The food label was necessary to facilitate informed choicec or to prevent false, misleading or unreliable conduct (Rumble et al., 2003). This is supported by Philipson (2005) and Tarasuk (2006) in their research which state that labelling statements on the food product can make consumers better informed and more health conscious. Currently, it is familiar that many disease are diet related and can be control or prevented throughout an appropriate diet and therefore to change eating pattern, sufficient information such as nutritional information must be provided at the point of purchase (Cunningham and Sobolewski, 2011) and thus it can make simpler the whole concept of healthy eating (Prathiraja and Ariyawardana, 2003) and useful for making better food choices (Borra, 2006; Grunert et al., 2010). In addition, balanced nutrition is a key element to ensure a happy and healthy life (Sharadamma et al., 2011).
On the other hand, several problems do occur regarding the uses of food label, for instance, some consumers do not understand food nutrition label well enough to make healthy food choices (Pelletier et al., 2004). Thus, inappropriate food choice may cause diet are high in calories, fat, sodium and refined carbohydrates (Fatimah et al., 2010). Research has found that high education people more likely to use food labels (Blitstein and Evans, 2006). Other than that, according to Hiew et al. (2010) respondents with at least a diploma had an extensively better level of knowledge of Nutrition Information Panel than those with a primary level education and better in food choices. In addition, children also recommended expanding their nutrition knowledge to select healthy food choices at schools, homes and in restaurants (Eboh and Boye, 2006). Furthermore, Islam and Ullah (2005) found that educational status have significant influence on knowledge and attitude of pregnant women toward nutrition. But another research done by Ahmadi et al. (2009), Al-Numair (2004) and Ozcelik et al. (2007) found that physicians do not have enough knowledge about nutrition and thus they need more education in nutrition to facilitate them during using nutritional information.
There are many factors being considered during buying the food products such as packaging, price, taste and nutritional labelling (Harnack et al., 2008). Besides, the type of nutrition information used also influence the students understanding toward nutrition information thus influence them to read or not the labels. For example, different formats are used in different countries leading to confusing to the consumers during food purchasing decision. The present study was designed to determine the association between students knowledge, attitude and practices on the use of food labels and to determine the factors that influence the use of food labels during making food purchasing decisions.
MATERIALS AND METHODS
Subjects: A cross-sectional study of undergraduate students at UiTM Puncak Alam in the Kuala Selangor district of Malaysia was conducted in June until July 2011 with a target group of diploma and degree students between 18-26 years old. All students studying in the Faculty of Health Sciences, Faculty of Pharmacy and Faculty of Office Management and Technology at UiTM were invited to participate in the study but only full-time and registered students were selected during the study period. By using a precision of 0.05 at a 95% confidence interval, the minimum sample size calculated by a single proportion formula. A non-probability sampling method (convenience sampling) was used to sample all the university students (n = 329).Three hundred twenty nine students (n = 329) volunteered to complete a Food Label Use Questionnaire (FLUQ). Ethical approval was obtained from the university before implementing this research. The questionnaires were distributed to the students during the day of data collection and were collected during that time. The students who not able to answer during that time, the questionnaires were collect on the next day. Students were assured that their participants were voluntarily and the questionnaires were anonymous.
Questionnaire: A Self-administered questionnaire FLUQ that was modified from Blitstein and Evans (2006), Lewis et al. (2009) and a knowledge, attitude and practice study on food and nutrition (KAP) was used to assess the relationship between knowledge, attitude and practices on food label use among students at UiTM Puncak Alam. The FLUQ consisted of 26 questions; it included question about sociodemographics, level of knowledge about food and nutrition, attitude and practices related to using food labels, factors affecting the use of food labelling and student understanding and preferences for different nutrition information formats. To establish content validity, the questionnaire had been pre-tested and improved for intended purpose and usefulness. The questionnaire consisted of four main sections. Section A collected demographic data. The important question was the frequency of using food label by using 4-likert scale with answer ranging from often to never. There were eleven questions about students demographics data, included sex (male or female), age, faculty, year (1, 2, 3 or 4), height, weight, BMI which categorized participants as normal weight (BMI < 25), overweight (25<BMI<30) or obese (BMI>30) and marital status, family income and level of education. Section B contained 8 multiple questions of food and nutrition. Section C contained the question about attitude on food label uses among UiTMs students were asked by using the 4-part Likert-type response set included most important, important, least important and not important. It also includes 2 questions about the factors influences the use of food labels during making food purchasing decision. The students can choose more that one answer based on the question about why refer the food label and hy do not refer the food label. Section D contained the question about practices on food label use, it were asked by using 4-part Likert-type response set included often, sometimes, rarely and never which was asked about the frequency of reading labelling on nutritional label such as total fat, calories from fat, trans fat, saturated fat (SF), cholesterol (chol), carbohydrate (CHO), protein, fibre, sugar, vitamin and mineral.
Statistical analysis: The data collected was analysed using Statistical Package for Social Sciences (SPSS), version 17.0 (SPSS Inc. Chicago, IL, USA). Hypothesis testing was completed using Independent T-test, Pearson Chi-square and descriptive analysis in which the statistical significant level was set at p<0.05. The categorical variable results are presented as frequency and its percentage and the numerical variable results are presented as the Mean±SD.
Subject demographics: A total of 329 students were sampled, with the majority of the participants being female and most of them being Malays. The Mean±SD ages of the male (n = 57) and female (n = 272) students were 20.6±1.5 and 20.9±1.5, respectively. The number of students from diploma level was 156 students (43.9% male students and 48.2% female students) while from degree level was 173 students (56.1 male students and 51.8 female students). The students are selected from three faculty which is from Health Science (n = 220), Pharmacy (n = 20) and Office Management and technology (n = 89) correspondingly. Most respondent (68.4% male students and 62.5% female students) were reported to have a BMI in the normal BMI category, respectively (Table 1).
|Table 1:||Characteristic of study populations|
|BMI: Body Mass Index, n = No. of respondent|
|Table 2:||Level of nutrition knowledge|
|n = No. of respondent|
Level of nutrition knowledge: The majority of the students have high knowledge about basic nutrition knowledge (55% students) followed by medium level of nutrition knowledge (35.3% students) and low nutrition knowledge (9.7% students) respectively. Based on the table, can conclude that the female student have slightly high knowledge (57.7%) compare to male students (42.1%), respectively. The range of scores for each level was as follows which based on 7Q: High (6.0-7.0), Medium (4.0-5.0) and Low (1.0-3.0) (Table 2).
Frequencies of nutrition information use on food label during food purchasing decision according to gender: The majority of the students are sometimes use of food label during buying food product which is about 120 (36.5%) students from 329 students.
|Table 3:||Frequency of food label use during food purchasing decision according to gender|
|n = No. of respondents|
|Table 4:||Association between knowledge on food label use|
|bp>0.05 indicate that is not significant association between knowledge and food label use|
It was followed by rarely use of food label (34% students), often use (21.6% students) and never use (7.9% students) respectively (p = 0.097). If compared based on the gender, male are often use the food label compared to female with 28.1 and 20.2% for each gender (Table 3). Conversely, majority of the female students are sometimes use the food label during food purchasing decision which is about 38.2% while majority of the male students (29.8%) are rarely use of food label during their food purchasing decision. However, there were no significant association between gender and the use of food label use during food purchasing decision (p = 0.097).
Association between knowledge on food label use: Majority of the students are sometimes use the food label during making food purchasing decision which is about 36.5% of the total students (n = 329). The students that have high knowledge of nutrition knowledge was 55% but only 24.9% of them are often use the food label during buying food product and 5.5% of them never use the food labels. There were no significant association between level of nutrition knowledge and the use of food label during making food purchasing decision (p = 0.080) (Table 4).
Association between attitudes on food label use: The item that was important for the students during buying food products are classified as attitude question same with the factors affecting the use of food labelling. Majority of the students stated that the price (50.2%), taste (53.8%), ingredient (52.3%) and expiry date (90.6%) was the most important aspect that makes them buying the food. But, most of them are rarely used the nutrition information. In addition, less than half of them which stated that price, taste, ingredient and expiry date are the most important aspect during buying are often use nutrition information on food labels (Table 5a). The factors affecting the use of food labelling are presented in Table 5b and c.
|Table 5a:||Association between attitudes (important aspect during buying food product) on food label use|
|ap-value<0.05 indicate that it have significant association between attitude and the use of food labels, bp-value>0.05 indicate that it not significant association between attitude and the use of food labels|
Table 5b shows the factors why the students read the food label. Majority of the students read the food labels because they understand each information on food labels (63.2%) followed by for health or beauty (50.8%), concern about taste and price (42.9%), to control energy intake reported only 29.5%, experience food allergy (15.2%) and another 4% was for others reasons such as to know whether the food have the logo halal or not. Table 5b represent the factor why the students do not refer the food label during buying food products. It was because of the time constrain which reported about 55.9% of the students, followed by label was not attractive (38.6%), there is no label on certain food (26.4%), no health problem (24.3%), do not know how to use food label/nutrition information (17.9%) and about 1.8% for others reasons such as not enough info about the food product. However, most of the students attitude were not significant associated on nutritional information use except for do not know how to use nutritional information label (p = 0.028) and label was not attractive (p = 0.037) were significantly associated on food label use.
Association between practices on food label use: Based on the Table 6a-c it shows that majority of the students are sometimes read the item or labelling on the food label. About half of the students sometimes read the list of ingredient (53.8%), serving size (50.5%), health claim (55.6), calories/energy (50.8%) and fibre which are about 51.1%, respectively.
|Table 5b:||Association between attitudes (read food label) on food label use|
|ap-value<0.05 indicate that it have significant association between attitude and the use of food labels, b p-value>0.05 indicate that it not significant association between attitude and the use of food labels|
|Table 5c:||Association between attitudes (Do not refer food label) on food label use|
|ap-value<0.05 indicate that it have significant association between attitude and the use of food labels, bp-value>0.05 indicate that it not significant association between attitude and the use of food labels|
|Table 6a:||Association between practices on food label use|
|ap-value <0.05 indicate that it have significant association between practices and the use of food labels. bp-value>0.05 indicate that it not significant association between practices and the use of food labels|
Most of the labels were significantly associated with the use of nutrition information on food labels (p<0.05) except for reading the label of sodium (p = 0.188), total fat (p = 0.064), carbohydrate (p = 0.301) and vitamin and mineral (p = 0.315) were not significant associated with the use of nutrition information on food labels.
A recent study has suggested identifying the use of nutrition information panels and sociodemographic variables among adults who make household food purchasing decisions. Like others studies, conversely, this was based on the association between knowledge, attitude and practices on food label use among students. No studies that being aware of examine this association and the factors affecting the use of nutrition information on food labels among students. This study found that majority of the students either male or female are sometimes used the food label during making food purchasing decision. The present study stated those males are less likely to use nutrition information on food label than females (Blitstein and Evans, 2006; Kim et al., 2000). Surprisingly, this study showed that male students are often use the food label compared to female where most of the female are sometimes used the food labels during their food purchasing decisions.
|Table 6b:||Association between practices on food label use|
|ap-value<0.05 indicate that it have significant association between practices and the use of food labels. bp-value>0.05 indicate that it not significant association between practices and the use of food labels|
But why do female students are sometimes not often using nutrition information consistently that male students? One reason may be in their minds the female students have limited time to read the label and more than worried about the assignment given and their education than to spend time reading the nutrition information on every purchase of food products. However, there were no significant association between gender and the use of food label use during food purchasing decision (p = 0.097).
Previous studies have shown that level of knowledge influence the using of food label. It is supported by Blitstein and Evans (2006) stated that higher levels nutrition knowledge was more likely to use nutrition information on food label when making food purchasing decision than those who are low education. Additionally, those with higher education appear to be more able of interpreting the information provided on nutrition labels and incorporate that information into a healthy diet (Prathiraja and Ariyawardana, 2003; Kim et al., 2000; Barreiro-Hurle et al., 2010). Similar to the study done by Marietta et al. (1999) found that knowledge was positively correlated with use of food labels. It shows that educated people was more nutrition conscious to get better food choices and healthy eating. But according to Onay et al. (2011) stated that those customers with lower educational levels were found to display more conscious consumer attitudes during food purchasing decision. In this study shows no significant association between level of bnutrition knowledge and the use of food labels.
|Table 6c:||Association between practices on food label use|
|ap-value <0.05 indicate that it have significant association between practices and the use of food labels, bp-value>0.05 indicate that it not significant association between practices and the use of food labels|
The students that have high knowledge about nutrition was 55% but only 24.9% of them are often use the food label during buying food product while 5.5% of them never use the food labels. This shows that the student that have high knowledge about nutrition do not use it to guide them during buying food products.
There are many factors being considered during buying food products such as packaging, price, taste, nutritional content and expiry date. According to Harnack et al. (2008) found that taste was the most highly factors rated when buying food from groceries. It is supported by Drichoutis et al. (2006) and Goodman et al. (2011), which stated that the meal planner especially may be more interested in taste than nutrition information. Furthermore, the research done by Aktas et al. (2009), revealed that there is significant different between the educational level of the university graduated students and the criteria they concern while purchasing like package, brand, contents, production date, expiry date, nutritional value and healthfulness. However, this study shows that expiry date was the higher factors when buying food product among students followed by taste, ingredient, price, nutrient content and lastly was packaging (21.6%). This may because of the students more aware about the safety of the food compared to taste and price which may not healthy and costly. It can see that nutrient content of the food not the higher factors during buying.
Furthermore, majority of the students attitude read the food labels because they understand each information on food labels (63.2%) followed by for health or beauty (50.8%), concern about taste and price (42.9%), to control energy intake reported only 29.5%, experience food allergy (15.2%) and another 4% was for others reasons such as to know whether the food have the logo halal or not. According to Driskell et al. (2008), the most frequently selected reasons for using nutrition label were because have general knowledge (51.7%), concern about overall health (49.2%), calorie counting (46.7%) and concern about certain nutrient (43.3%). This shows that the reasons why the student use nutrition label on food label because they understand the information on the label. Yet, the factors why do the students do not refer food label was time constrain or limited time (55.9% students) and the label was not attractive and confusing (38.6%). This finding had a similar finding as previous study conducted by Conklin et al. (2005), stated that the time pressure may influence the use of nutrition information. It supported by Barreiro-Hurle et al. (2010) which state that the use of food label is influences by economic conditions and time constraints. All of these findings show that the majority of the consumers have limited time to read the food label and understand it during buying food product. They assume that they know what they want to buy and there is no point to waste the time to read the food label and do calculation on groceries but finally they will buy the food even though it not meet the nutrient requirement. However, the association between attitude on food label or nutrition information use with varying results.
Based on the Table 6a-c it shows that most of the 15 items that appear on Nutrition Facts label are significantly associated with the use of food label (p<0.05). So, there is significantly association between practices and the use of food labels. This value provides insight into the relative importance students placed on each of these items. According to Borra (2006), the consumers were most aware and practice to read the label of calories (89%), followed by total fat (81%), sodium (75%), sugar (73%) carbohydrate (72%), saturated fat (71%) and cholesterol (66%). This shows that the consumer more aware on the fat content in a food product which it may because of the health conscious and to control their weight. But in this study, practices by reading the list of ingredient and health claim was the highest among others labels. It is supported by the research done by Driskell et al. (2008), which state that female Canadian university students more prone to read ingredient information than others item label. This may be due to religious factors that prohibit them from consuming any sources that prohibited by religion or any other chemical or substance added to the food that can cause allergic reaction.
The limitation of this study was the participants involved were mostly Malay students which limit the generalisability of the finding. It may not reflect the true features of the Malaysians students.
Overall, students have mixed views on food labelling. Some find it useful for making better choices, whereas others believed it is too complicated, taking time and as students it should be easier to use. For undergraduate university students, taste and price may the most highly rated factor when buying food product rather that nutritional labelling. It may due to limited budget, time constrain and just to get energy and full their appetite. However, information concerning the use of food label was limited. This finding also suggest that the program about the important of food labelling and how to use it should be held and give awareness to the students that reading food labels as one of many strategies, along with controlling portions, making better food choice, exercising getting more sleep, drinking more water and others. Further research is needed to understand this association and the factors influence the use of food label in detail.
The authors gratefully acknowledge the support and help of the colleagues for collected data. This work was supported by UiTM EXCELLENT FUND grants No: 600-RMI/ST/DANA 5/3/Dst (169/2011). The authors wish to thank the UITM students who participated in the study.
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