Recall, understanding, use, and impact of front-of-package warning labels on ultra-processed foods: A qualitative study with mothers of preschool children in Peru.

In its efforts to reduce increasing rates of obesity and nutrition-related noncommunicable diseases, Peru implemented front-of-package (FOP) warning labels (also called warnings) on processed and ultra-processed foods in June 2019. The goal was to inform consumers about high levels of sugars, saturated fats, sodium, and trans fats in packaged products. We designed a qualitative study to reveal the recall, understanding, and use of the warnings and to explore the perceived changes in purchasing behaviors among mothers of preschool children in Peru. In mid-2021 we conducted 18 focus groups with 98 mothers from 2 socioeconomic strata (SES) residing in 4 geographically and culturally diverse cities. We analyzed the focus group transcripts for themes relating to the mothers' awareness, understanding, and use of the warnings and the warnings' influence. Our results show that most mothers remembered the warnings and understood their general purpose and meaning, although some warnings were more easily remembered and understood than others. For example, sugar was easier than trans fats. Many mothers considered the warnings in their purchase decisions, although the impact of the warnings on final purchase decisions varied. The warnings were less effective for products that mothers already knew were high in critical nutrients, that they considered essential for certain preparations (e.g., butter), or that they enjoyed (e.g., chocolate). Most mothers reported changes in their purchasing and eating habits due to the warnings, mainly in reducing the frequency and quantity of some processed food intake and opting instead for homemade preparations or warning-free packaged products. Our study shows the usefulness of the FOP warning labels for informing consumers from different settings and SES about the healthfulness of packaged products. The study identifies key areas in which Peru can improve the policy and offers valuable lessons for other countries interested in the implementation of FOP warning labels.