Poor diet and obesity are major causes of cardiovascular diseases (CVD). Requiring pictorial health warnings on the front of food packaging is a promising yet understudied policy to reduce dietary risk factors for CVD. This strategy has potential to improve public health, including among Latinos, the largest minority group in the US. The goal of my proposed research and training is to design pictorial food health warnings to reduce dietary risk factors for CVD, with attention to the effects among Latinos with low English proficiency (LEP).
In Aim 1, I will develop English-language pictorial food health warnings linking nutrients (i.e., saturated fat, sodium, sugar) with CVD consequences, with guidance from a panel of experts in nutrition, cardiovascular health, and law. I will pre-test the resulting food health warnings in focus groups with US adults, including LEP Latinos. In a discrete choice experiment, I will select the final warnings for use in Aims 2 and 3.
In Aim 2, I will evaluate whether pictorial warnings increase healthfulness of virtual food purchases in a virtual shopping experiment. I will randomly assign a sample of US adults (half LEP Latinos and half non-Latinos) to view pictorial warnings or control labels on food products in a virtual supermarket and will test whether pictorial warnings increase healthfulness of virtual food purchases (i.e., reduce calories, saturated fat, sugar, and sodium of purchases). I will also examine whether LEP status moderates the impact of pictorial warnings on food purchases. I expect the impact of pictorial warnings will be stronger among LEP Latinos than non-Latinos because the images paired with text will better communicate risk than text alone. Finally, in Aim 3, I will randomly assign US adults to view pictorial warnings or control labels and will assess whether pictorial warnings increase objectively-measured physiological responses to warnings including attention (i.e., dwell time, measured with eye tracking) and negative emotion (i.e., frowning and hand sweating, measured with electrodes). This research addresses NHLBI's strategic goal of reducing CVD, as well as the Institute's overarching objective to investigate factors that account for health disparities. The K01 will help me achieve my long-term career goal of becoming a leader in behavioral research to inform obesity prevention policy, with a focus on Latino health disparities. With support from this career development award, I will build an independent research program to improve understanding of how to design effective policies to prevent poor diets and diet-related obesity. Specifically, the K01 will allow me to address training gaps in 1) modifiable dietary determinants of CVD, with a focus on Latino disparities, 2) discrete choice experiments, and 3) eye tracking methodology. My training plan includes apprenticeships with my interdisciplinary mentorship team, formal coursework, hands-on research activities, and participation in national conferences, research groups, and professional societies. The K01 will provide me with the experience necessary to become an independent researcher capable of successfully competing for R01 funding to continue work in this area.

Public Health Relevance

Poor diet and obesity are major risk factors for cardiovascular diseases in the US, especially among Latinos. Requiring pictorial health warnings on food products could reduce dietary risk factors for cardiovascular diseases, but this promising policy approach has been understudied. The proposed research will evaluate the impact of pictorial health warnings for food on virtual food purchases, attention, and negative emotion, with a focus on Latinos in the US with limited English proficiency.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Scientist Development Award - Research & Training (K01)
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NHLBI Mentored Clinical and Basic Science Review Committee (MCBS)
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Boyington, Josephine
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University of North Carolina Chapel Hill
Internal Medicine/Medicine
Schools of Medicine
Chapel Hill
United States
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