Search

OBJECTIVE: This study aimed to examine consumer knowledge of tetrahydrocannabinol (THC) and cannabidiol (CBD) levels for usual cannabis products. METHODS: Data are from the International Cannabis Policy Study conducted online in August–September 2018. Respondents included 6471 past 12-month cannabis users, aged 16–65 years, recruited from the Nielsen Global Insights Consumer Panel using nonprobability methods. Respondents were recruited from Canada, which had not yet legalized nonmedical cannabis (n=2354), and US states that had (n=2160) and had not (n=1957) legalized nonmedical cannabis. RESULTS: Participants reported descriptive THC:CBD ratios (e.g., high THC, low CBD) and numeric THC and CBD levels (mg or %) for products they usually use in each of nine product categories. Few consumers knew and were able to report the numeric THC or CBD levels of their usual cannabis products. For example, only 10% of dried herb consumers reported the THC level, approximately 30% of whom reported implausible values. A greater proportion of consumers reported a descriptive THC:CBD ratio of their usual product, ranging from 50.9% of edible users to 78.2% of orally ingested oil users. Consumers were substantially more likely to report products high in THC versus low in THC for all products except topicals and tinctures, whereas similar proportions reported using products high and low in CBD. Despite some evidence of greater knowledge in legal jurisdictions, knowledge was still low in states with legal cannabis markets. CONCLUSIONS: Consumer knowledge of THC and CBD levels was low, with only modest differences between consumers living in jurisdictions that had and had not legalized nonmedical cannabis. The findings cast doubt on the validity of self-reported cannabinoid levels.

The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of daily life, including dietary intake; however, few studies have reported its impacts on dietary behaviors and food security across multiple countries.We examined self-reported impacts of COVID-19 on food behaviors, food security, and overall diet healthfulness in 5 countries.Adults aged 18-100 years (n = 20,554) in Australia, Canada, Mexico, the United Kingdom, and the United States completed an online survey in November and December 2020 as part of the International Food Policy Study, an annual, repeat cross-sectional survey. Survey measures assessed perceived impacts of the COVID-19 pandemic on eating food prepared away from home, having food delivered from a restaurant, and buying groceries online, as well as perceived food security and overall diet healthfulness. Regression models examined associations between each outcome and sociodemographic correlates.Across all countries, 62% of respondents reported eating less food prepared away from home due to the pandemic, while 11% reported eating more. Some participants reported having less food delivered from a restaurant (35%) and buying fewer groceries online (17%), while other respondents reported more of each (19% and 25%, respectively). An average of 39% reported impacts on their food security, and 27% reported healthful changes to their overall diet. The largest changes for all outcomes were observed in Mexico. Participants who were younger, ethnic minorities, or had lower income adequacy tended to be more likely to report food-related changes in either direction; however, these relationships were often less pronounced among respondents in Mexico.Respondents reported important changes in how they sourced their food during the pandemic, with trends suggesting shifts towards less food prepared away from home and more healthful diets overall. However, changes in diet and food behaviors occurred in both healthful and less healthful directions, suggesting that dietary responses to the pandemic were highly variable.

BACKGROUND: Diets that reduce reliance on animal-source foods are recommended in some contexts. OBJECTIVES: This study aimed to compare proportions of respondents who reported following meat-reduced dietary practices (i.e., vegetarian, vegan, or pescatarian diets) and/or making efforts to reduce animal-source foods, and to examine sociodemographic correlates across 5 countries. METHODS: Online surveys were conducted in November and December 2018 and 2019 with 41,607 adults from Australia (n = 7926), Canada (n = 8031), Mexico (n = 8110), the United Kingdom (n = 9129), and the United States (n = 8411) as part of the International Food Policy Study. Respondents were asked whether they would describe themselves as vegetarian, vegan, or pescatarian, and whether they had made efforts to consume less red meat, less of all meats, or less dairy in the past year. Logistic regressions examined differences in the likelihood of each behavior between countries and sociodemographic subgroups. RESULTS: Approximately 1 in 10 respondents reported following a vegetarian, vegan, or pescatarian diet, ranging from 8.6% (Canada) to 11.7% (UK). In the past 12 months, the proportions of respondents who reported efforts to consume less red meat ranged from 34.5% (Australia) to 44.4% (Mexico), less of all meats ranged from 27.9% (US) to 35.2% (Mexico), and to consume less dairy ranged from 20.6% (UK) to 41.3% (Mexico). Respondents were more likely to report efforts to consume less animal-source products in 2019 compared to 2018 in most countries. Sociodemographic patterns varied by country; in general, women, those with higher education levels, and those in minority ethnic groups were more likely to report following meat-reduced dietary practices or efforts to consume fewer animal-source products. CONCLUSIONS: Nearly half of respondents reported following a meat-reduced diet or efforts to reduce animal-source products, with differences between countries and population subgroups. Population-level approaches and policies that support meat reduction may further reduce consumption of animal-source products.

Nonmedical cannabis is legal in Canada and several U.S. states. Displacing the illegal market is a primary goal of legalization; however, there are little data on factors that predict consumers' transition from the illegal to the legal market. The current study aimed to examine reasons for purchasing illegal cannabis and, thus, potential barriers to purchasing legal cannabis among consumers in Canada and U.S. states.Data are from the 2019 and 2020 International Cannabis Policy Study, a repeat cross-sectional survey conducted among 16- to 65-year-olds. Reasons for purchasing illegally in the past 12 months were asked of male and female cannabis consumers in Canada and U.S. legal states (In both years, the most commonly reported barriers to legal purchasing were price (Canada: 35%-36%; United States: 27%) and inconvenience (Canada: 17%-20%; U.S.: 16%-18%). In 2020 versus 2019, several factors were less commonly reported as barriers in Canada, including inconvenience (17% vs. 20%,Higher prices and inconvenience of legal sources were common barriers to purchasing legal cannabis. Future research should examine how perceived barriers to legal purchasing change as legal markets mature.

Few studies have compared knowledge of the specific health risks of cannabis across jurisdictions. This study aimed to examine perceptions of the health risks of cannabis in Canada and US states with and without legal non-medical cannabis. Cross-sectional data were collected from the 2018 and 2019 International Cannabis Policy Study online surveys. Respondents aged 16–65 (n = 72 459) were recruited from Nielsen panels using non-probability methods. Respondents completed questions on nine health effects of cannabis (including two ‘false’ control items). Socio-demographic data were collected. Regression models tested differences in outcomes between jurisdictions and by frequency of cannabis use, adjusting for socio-demographic factors. Across jurisdictions, agreement with statements on the health risks of cannabis was highest for questions on driving after cannabis use (66–80%), use during pregnancy/breastfeeding (61–71%) and addiction (51–62%) and lowest for risk of psychosis and schizophrenia (23–37%). Additionally, 12–18% and 6–7% of respondents agreed with the ‘false’ assertions that cannabis could cure/prevent cancer and cause diabetes, respectively. Health knowledge was highest among Canadian respondents, followed by US states that had legalized non-medical cannabis and lowest in states that had not legalized non-medical cannabis (P

Warning labels are an important source of health information. This study examined awareness of health warnings on cannabis packages over time in Canada-where large rotating messages are mandated-versus US states with legal adult-use cannabis, which have less comprehensive regulations.Repeat cross-sectional data were collected from the International Cannabis Policy Study online surveys among past 12-month cannabis consumers in Canada and the US (Free recall of ≥1 warning increased to a greater extent in Canada from 2018 (5%; pre-legalization) to 2019 (13%; post-legalization) compared to US "legal" (AOR = 1.93,Cannabis legalization is associated with greater recall of health warning messages. Awareness of specific warning messages was higher in jurisdictions where the associated warning was mandated on packages, suggesting that warning labels may improve knowledge of cannabis-related health risks.Supplemental data for this article is available online at.

Introduction: Increasing cannabis legalization raises concerns that the use of tobacco, frequently used with cannabis, will also increase. This study investigated the association between the legal status of cannabis in places of residence and the prevalence of cannabis and tobacco co-use, simultaneous use, and mixing by comparing the prevalence among adults in Canada (prior to cannabis legalization) vs. adults in US states that had legalized recreational cannabis vs. US states that had not as of September 2018. Methods: Data were drawn from the 2018 International Cannabis Policy Study, conducted with respondents aged 16–65 in Canada and the US recruited from nonprobability consumer panels. Differences in the prevalence of co-use, simultaneous use, and mixing between tobacco and different cannabis products were examined using logistic regression models by legal status of place of residence among past-12-month cannabis consumers (N = 6744). Results: Co-use and simultaneous use in the past 12 months were most common among respondents in US legal states. Among cannabis consumers, co-use and simultaneous use were less common in US legal states, while mixing was less frequent in US states with both legal and illegal cannabis compared to Canada. Use of edibles was associated with lower odds of all three outcomes, while smoking dried herb or hash was associated with higher odds. Conclusions: The proportion of cannabis consumers who used tobacco was lower in legal jurisdictions despite higher prevalence of cannabis use. Edible use was inversely associated with co-use, suggesting that edible use does not appear to be associated with increased tobacco use.

Product labelling and health warnings are important components of regulatory frameworks for consumer products such as tobacco, alcohol and food. However, evidence in the cannabis domain is limited. This study aimed to examine the reach of mandated health warnings on cannabis products using a natural experimental design.Data are from the online International Cannabis Policy Study 2018 and 2019 surveys. Respondents were men and women aged 16 to 65 years in Canada and US states with illegal and legal nonmedical cannabis ("illegal" and "legal" states, respectively) (n = 72 549). Regression models tested differences in noticing health warnings on cannabis packages pre- and post-legalization in Canada, with comparisons to US states, adjusting for cannabis use, cannabis source and sociodemographics.Respondents in Canada showed a greater increase in noticing warnings (+8.9%) in 2019 (14.7%) versus 2018 (5.8%) than respondents in US "illegal" states (+2.8%) and "legal" states (+3.2%). In 2019, consumers residing in jurisdictions with legal recreational cannabis who purchased from legal retail sources were more likely to report noticing warnings than consumers who obtained cannabis from illegal/unstated sources (Canada: 40.4% vs. 15.3%; US "legal" states: 35.3% vs. 17.0%). Regular cannabis consumers were more likely to notice warnings than less frequent consumers.Mandating warning labels on cannabis products may increase exposure to messages communicating the health risks of cannabis, especially among frequent consumers and those who access the legal market.L’étiquetage des produits et les mises en garde concernant la santé sont des éléments importants de la réglementation des produits de consommation comme le tabac, l’alcool et les aliments. Or on dispose de peu de données dans le domaine du cannabis. Cette étude visait à examiner la portée des mises en garde obligatoires concernant la santé sur les produits du cannabis, en s’appuyant sur un protocole expérimental naturel.Les données sont issues des sondages en ligne de l’International Cannabis Policy Study de 2018 et de 2019. Les répondants (n = 72 549) étaient des hommes et des femmes ayant entre 16 et 65 ans vivant au Canada ou dans un État américain interdisant la consommation non médicale de cannabis (État « à consommation illégale ») ou un État américain l’autorisant (État « à consommation légale »). Des modèles de régression ont été utilisés pour tester les différences sur le plan de la perception des mises en garde concernant la santé sur les emballages de cannabis avant la légalisation au Canada et après celle-ci comparativement aux États américains, après ajustement pour la consommation de cannabis, le fournisseur du cannabis et les données sociodémographiques.Dans l’ensemble, la perception des mises en garde a davantage augmenté entre 2018 et 2019 chez les répondants au Canada (+ 8,9 %, soit 14,7 % en 2019 contre 5,8 % en 2018) que chez les répondants aux États-Unis, que ce soit dans les États à consommation illégale (+ 2,8 %) ou dans les États à consommation légale (+ 3,2 %). En 2019, les consommateurs résidant dans des zones où le cannabis à usage récréatif est légal et qui l’ont acheté auprès de détaillants autorisés étaient plus susceptibles de mentionner avoir remarqué les mises en garde que les consommateurs s’étant procuré du cannabis auprès de fournisseurs non autorisés ou non déclarés (Canada : 40,4 % contre 15,3 %; États américains à consommation légale : 35,3 % contre 17,0 %). Les consommateurs réguliers de cannabis étaient plus susceptibles de remarquer les mises en garde que les consommateurs occasionnels.Rendre obligatoires les étiquettes de mise en garde sur les produits du cannabis est susceptible d’accroître l’exposition à des messages indiquant les dangers du cannabis pour la santé, en particulier chez les consommateurs fréquents et les personnes s’approvisionnant sur le marché légal.The aim of this study was to examine noticing of mandated health warnings on cannabis products. Compared to respondents in US states, respondents in Canada noticed more health warnings after nonmedical cannabis legalization in 2019 versus pre-legalization in 2018. Purchasing cannabis from legal sources was associated with increased noticing of health warnings. Regular cannabis consumers were more likely to notice warnings than less frequent consumers. Mandating warning labels on cannabis products may increase exposure to messages communicating the health risks of cannabis, especially among frequent consumers and those who access the legal market.Cette étude visait à examiner la perception des mises en garde obligatoires concernant la santé sur les produits du cannabis. Comparativement aux répondants des États américains, ceux du Canada ont davantage remarqué les mises en garde concernant la santé en 2019 qu’en 2018 avant la légalisation de la consommation non médicale de cannabis au Canada. L’achat de cannabis auprès de fournisseurs autorisés a été associé à une augmentation de la perception des mises en garde concernant la santé. Les consommateurs réguliers de cannabis étaient plus susceptibles de remarquer les mises en garde que les consommateurs occasionnels. Rendre obligatoires les étiquettes de mise en garde sur les produits du cannabis est susceptible d’accroître l’exposition à des messages indiquant les dangers du cannabis pour la santé, en particulier chez les consommateurs fréquents et les personnes qui s’approvisionnent sur le marché légal.

Purpose: To compare the perceived healthiness of different sweeteners relative to table sugar and examine efforts to consume less sugars and sweeteners. Methods: As part of the 2017 Canada Food Study online survey, 1000 youth and young adults were randomized to rate the healthiness of 1 of 6 sweeteners (aspartame, sucralose, stevia, agave, high-fructose corn syrup, “raw” sugar) or 1 sweetener brand name (Splenda) compared with “table sugar”. Results: Perceptions of sweeteners varied widely. For example, the majority of respondents perceived high-fructose corn syrup (63.9%) and aspartame (52.4%) as less healthy than table sugar, whereas almost half (47.8%) perceived raw sugar as being healthier than table sugar. No assessed socio-demographic variables were significantly associated with perceived healthiness of sweeteners compared with table sugar (P ≥ 0.05). More consumers had attempted to consume less sugar (65.4%) compared with less “artificial” (31.2%) or “natural” (24.0%) low-calorie sweeteners. Conclusions: Perceptions of sweetener healthiness may be related to sweeteners’ perceived level of “naturalness” rather than energy content. This has important implications for understanding consumer preferences, particularly given greater use of low-calorie sweeteners in the food supply and policy developments such as sugar taxes and enhanced sugar labelling.

Objective:In February 2020, San Francisco proposed mandatory health warnings for sugar-sweetened beverage (SSB) advertisements. Industry legal challenges stated that the warning would detract from advertisers’ ability to convey their intended message and mislead consumers into believing that SSB cause weight gain regardless of consumption amount, lifestyle or intake of other energy-dense foods.Design:Online between-group experiments tested the impact of SSB warnings on advertising outcomes and consumer perceptions. Respondents were randomised to view six SSB print advertisements with or without a health warning (‘Warning’ and ‘No Warning’ condition, respectively). Linear and binary logistic regression models tested differences between groups, including ad recall, brand perceptions and beliefs about SSB health effects.Setting:Panelists from the US Nielsen Global Panel.Participants:Sixteen to 65-year-old respondents (n 1064).Results:Overall, 69·2 % of participants in the ‘Warning’ condition recalled seeing warnings on SSB ads. Compared with the ‘No Warning’ condition, participants in the ‘Warning’ condition who reported noticing the warnings were equally likely to recall the brands featured in the SSB ads and to recall specific attributes of the final ad they viewed. Similarly, no differences were observed between groups in perceptions of SSB, such as perceived taste, or in the prevalence of false beliefs regarding the health effects of SSB and intake of other sugary foods on weight gain.Conclusions:Overall, there was no evidence that SSB health warnings detracted from attention to promotional elements in advertisements or that the warnings misled consumers into false beliefs about SSB as the exclusive cause of weight gain.

Objective:To examine awareness and recall of healthy eating public education campaigns in five countries.Design:Data were cross-sectional and collected as part of the 2018 International Food Policy Study. Respondents were asked whether they had seen government healthy eating campaigns in the past year; if yes (awareness), they were asked to describe the campaign. Open-ended descriptions were coded to indicate recall of specific campaigns. Logistic models regressed awareness of healthy eating campaigns on participant country, age, sex, ethnicity, education, income adequacy and BMI. Analyses were also stratified by country.Setting:Online surveys.Participants:Participants were Nielsen panelists aged ≥18 years in Australia, Canada, Mexico, UK and the USA (n 22 463).Results:Odds of campaign awareness were higher in Mexico (50·9 %) than UK (18·2 %), Australia (17·9 %), the USA (13·0 %) and Canada (10·2 %) (P < 0·001). Awareness was also higher in UK and Australia v. Canada and the USA, and the USA v. Canada (P < 0·001). Overall, awareness was higher among males v. females and respondents with medium or high v. low education (P < 0·001 for all). Similar results were found in stratified models, although no sex difference was observed in Australia or UK (P > 0·05), and age was associated with campaign awareness in UK (P < 0·001). Common keywords in all countries included sugar/sugary drinks, fruits and vegetables, and physical activity. The top five campaigns recalled were Chécate, mídete, muévete (Mexico), PrevenIMSS (Mexico), Change4Life (UK), LiveLighter® (Australia), and Actívate, Vive Mejor (Mexico).Conclusions:In Mexico, UK and Australia, comprehensive campaigns to promote healthy lifestyles appear to have achieved broad, population-level reach.

BACKGROUND AND AIMS: There is little information on consumption patterns across the diverse range of cannabis product types. This paper examines trends in consumption patterns in Canada and the United States (US) between 2018-2020. DESIGN: Repeat cross-sectional surveys were conducted as part of the International Cannabis Policy Study online survey in 2018 (n=27,024), 2019 (n=45,426), and 2020 (n=45,180). SETTING: Respondents were recruited from commercial panels in Canada and US states that had and had not legalized non-medical cannabis (US 'legal' and 'illegal' states, respectively). PARTICIPANTS: Respondents were male and female participants aged 16-65 years. MEASUREMENTS: Data on frequency and consumption amounts were collected for nine types of cannabis products, including dried flower and processed products (e.g., oils and concentrates). Consumers were also asked about mixing cannabis with tobacco. Socio-demographic information was collected. FINDINGS: Dried flower was the most commonly used product, although use in the past 12 months declined between 2018 and 2020 in Canada (81% to 73%), US legal (78% to 72%) and illegal states (81% to 76%; p

This study examines the prevalence of risky cannabis use based on adherence to the Lower-Risk Cannabis Use Guidelines.Respondents aged 16-65 years in Canada and the U.S. (N=27,024) completed the online 2018 International Cannabis Policy Study. Participants completed measures corresponding to the Lower-Risk Cannabis Use Guidelines and Alcohol, Smoking and Substance Involvement Screening Test. Analyses were conducted in 2019.More than half of the respondents (57.3%, n=15,489) had ever used cannabis, and 28.1% (n=7,584) had used it in the past 12 months (current use). The majority of current consumers (88.8%) reported nonadherence to ≥1 guideline other than ever use. These behaviors included smoking ≥50% of all cannabis consumed (69.8%), using high-tetrahydrocannabinol products (44.9%), initiating cannabis use before age 16 years (35.9%), daily/near-daily use (32.2%), driving after cannabis use (26.1%), cannabis use during pregnancy or with a history of psychosis or substance abuse (17.3%), and synthetic cannabis use (5.9%). More respondents in U.S. legal recreational cannabis states reported nonadherence than those in jurisdictions where recreational cannabis remained illegal. Specifically, consumers in U.S. legal states were significantly more likely to use high-tetrahydrocannabinol products than consumers in U.S. illegal states or Canada and more likely to drive after cannabis use than consumers in Canada (p0.001 for all). Adherence to Lower-Risk Cannabis Use Guidelines was strongly associated with Alcohol, Smoking and Substance Involvement Screening Test scores.Lower-Risk Cannabis Use Guideline adherence differed by jurisdiction and sociodemographic profile. As more jurisdictions legalize nonmedical cannabis, targeted interventions for key risk behaviors (e.g., using high-potency cannabis, early initiation age, driving after cannabis use) are warranted.

1,3-Butadiene is a known carcinogen primarily targeting lymphoid tissues, lung, and liver. Cytochrome P450 activates butadiene to epoxides which form covalent DNA adducts that are thought to be a key mechanistic event in cancer. Previous studies suggested that inter-species, -tissue, and -individual susceptibility to adverse health effects of butadiene exposure may be due to differences in metabolism, as well as other mechanisms. In this study, we aimed to examine the extent of inter-individual and inter-species variability in urinary N7-(1-hydroxy-3-buten-2-yl) guanine (EB-GII) DNA adducts, a well-known biomarker of exposure to butadiene. For a population variability study in mice, we used the Collaborative Cross model. Female and male mice from 5 strains were exposed to filtered air or butadiene (590 ppm, 6 h/day, 5 days/week for 2 weeks) by inhalation. Urine samples were collected, and the metabolic activation of butadiene to DNA-reactive species was quantified as urinary EB-GII adducts. We quantified the degree of EB-GII variation across mouse strains and sexes; then, we compared this variation with the data from rats (exposed to 62.5 or 200 ppm butadiene) and humans (0.004-2.2 ppm butadiene). We show that sex and strain are significant contributors to the variability in urinary EB-GII levels in mice. In addition, we find that the degree of variability in urinary EB-GII in Collaborative Cross mice, when expressed as uncertainty factor for the inter-individual variability (UF(H)), is relatively modest (≤ 3-fold), possibly due to metabolic saturation. By contrast, variability in urinary EB-GII (adjusted for exposure) observed in humans, while larger than the default value of 10-fold, is largely consistent with UF(H) estimates for other chemicals based on human data for non-cancer endpoints. Overall, these data demonstrate that urinary EB-GII levels, particularly from human studies, may be useful for quantitative characterization of human variability in the cancer risks to butadiene.

Little is known about exposure to secondhand cannabis smoke (SHCS) among residents of detached single-family homes and multiunit housing (MUH). Using data from the 2019 International Cannabis Policy Study, the prevalence of (a) self-reported exposure to SHCS at home (n = 33,024) and (b) self-reported SHCS incursions into MUH (defined as SHCS from another unit/the outdoors, n = 15,634) was estimated in (1) Canada; (2) US states where non-medical cannabis use was legal, and (3) US states where it remained illegal. Factors associated with exposures and incursions were assessed using weighted logistic regression. Overall, 16.9% of residents in Canada, 20.6% in US legal states, and 15.5% in US illegal states reported exposure to SHCS in their homes at least once in the previous month. One quarter (25.7%) of Canadian MUH residents, 26.6% from US legal states, and 20.1% from US illegal states reported at least monthly incursions. Sociodemographic factors associated with incursions suggested MUH residents reporting incursions lived in qualitatively different MUH than those not reporting incursions. Irrespective of the legality of non-medical cannabis use, smoke-free policies in MUH should protect residents from involuntary exposure to all types of secondhand smoke.

Background: In October 2018, Canada legalized non-medical cannabis. A primary goal of legalization is to reduce illicit market transactions; however, there is little ‘baseline’ data on the price and purchase sources of cannabis prior to legalization in Canada. This study examined the self-reported price of dried cannabis, quantity purchased, and sources used before retail stores opened. Methods: Data come from the baseline wave of the International Cannabis Policy Study (ICPS), a prospective cohort survey conducted in August–October 2018, immediately before legalization. Respondents were 1227 Canadians aged 16–65 years who reported purchasing dried cannabis in the past 12 months. Respondents were recruited using the Nielsen Consumer Insights Global Panel. A linear regression model examined price-per-gram by quantity purchased, source used, and socio-demographics. Results: Overall, the mean self-reported price-per-gram among cannabis users was C$9.56 (standard errors of the mean [SEM] = 0.2). The price-per-gram of cannabis significantly decreased as quantity purchased increased. For example, the mean price of cannabis purchased in smaller quantities (28 g) ($5.60/g, SEM = 0.2). The estimated quantity discount elasticity was −0.21 (95% CI: −0.25, −0.18). The most common purchase sources used were family member/friends (53.0%) and illicit street dealers (51.7%). Price-per-gram varied across sources; however, variation was largely accounted for by consumers purchasing different quantities at different sources. Conclusions: Variations in the price of dried cannabis were largely determined by the quantity purchased. The findings highlight the importance of accounting for purchase quantity when assessing cannabis prices, particularly in illicit markets.

Cannabis-impaired driving (CID) is associated with an increased risk of motor vehicle accidents. A number of studies have reported on the prevalence of CID and/or riding in a vehicle with a cannabi...

'Plain packaging' and health warnings can reduce appeal and increase risk perceptions of tobacco products. This study tested the effect of health warnings and restricted brand imagery on perceptions of cannabis products. Participants in Canada and the US (n = 45,378) were randomized to view packages of three cannabis brands in 2019. A 3 (health warning) x 4 (brand imagery) between-group factorial experimental design was used. Health warning conditions were: none, Canadian or US warning. The Canadian warning conditions had three messages counterbalanced across brands: pregnancy, adolescent risk, and impaired driving. The US warning mentioned the same broad risk categories. The four branding conditions ranged from packages displaying no brand imagery and uniform colours-'plain packaging'-to full brand imagery. Regression tested differences between conditions on product appeal, perceived harm, and free recall of warning messages. Overall, full branding and plain packaging were rated the most and least appealing, respectively (p 0.001). Products were rated as significantly less harmful when they had a white background with no or limited branding versus a coloured background (p ≤ 0.01). Products with health warnings were rated significantly less appealing and more harmful than those with no warning (p 0.001). Message recall was significantly higher for Canadian versus US health warnings, and for the US warning versus no warning (p 0.001). Message recall was greater among those who saw plain versus fully branded packages for two of the three warning messages (p 0.01). Prominent health warnings and restrictions on brand imagery may be warranted in jurisdictions considering non-medical cannabis legalization.

Highlights • LRCUG feature recommendations for users on how to reduce cannabis use-related risks. • Select cannabis use-related behavior data were identified in four Canadian surveys. • Except for modes of use, respective majorities of users comply with the LRCUG. • Substantial sub-groups of users engage in (possibly multiple) risk-behaviors. • Improved targeted interventions are required to lower risks and adverse outcomes., Canada, alongside other jurisdictions, implemented non-medical cannabis legalization in 2018, partly towards improving public health. Evidence-based ‘Lower-Risk Cannabis Use Guidelines’ (LRCUG), including recommendations for cannabis users on how to decrease risk-behaviors for harms, have been developed and widely disseminated in Canada since 2017. However, knowledge on users’ compliance with the LRCUG is limited. We identified four major Canadian (three national, one provincial) population surveys presenting key data on cannabis-related behaviors: the National Cannabis Survey, Canadian Cannabis Survey, Canadian Tobacco, Alcohol & Drugs Survey, and CAMH Monitor. We scanned each survey for indicator data mapping onto either of the LRCUG’s recommendations for the years 2017 to 2019. Relevant indicator data, albeit with varying operationalizations, were found for six of the ten LRCUG’s recommendation clusters in at least some of the surveys, and were extracted and summarized. For results, substantial -- but declining -- majorities of users consumed cannabis by smoking, yet with shifts towards other use modes. Between one- to two-in-five users engaged in the risk-behaviors of using high-potency cannabis products, frequent cannabis use and cannabis-impaired driving, respectively. A small proportion of pregnant or breastfeeding women continued cannabis use during the study period. The data identified found suggested a heterogeneous picture regarding cannabis users’ compliance with the LRCUG’s recommendations. Non-compliance is highest for recommendations regarding modes-of-use, and applies to minorities of users for other risks factors. These sub-groups are at elevated risk for acute (e.g., accidents) or long-term (e.g., dependence) cannabis-related harms contributing to the public health burden. Appropriate targeted interventions in these areas require improvement.

Background As states continue to legalize the sale of recreational cannabis, there is a need to study attitudes and behaviors regarding driving after cannabis use. The purpose of this study was to describe US adults' attitudes and behaviors regarding driving after cannabis use by state-level legal sale of recreational cannabis, and to determine whether these associations differ by frequency of cannabis use. Methods Data were collected from a national sample of 17,112 adults in the United States. Weighted adjusted prevalence ratios and 95% confidence intervals were used to compare the prevalence of behaviors and attitudes by state-level legal sale of recreational cannabis. Analyses were repeated among recent cannabis users, stratifying by cannabis use status. Results Driving after cannabis use was more prevalent in legal cannabis sales states; however, so were potentially protective attitudes related to cannabis use and driving. After stratifying by frequency of use, daily/almost daily, weekly/monthly, and past 12-month users from states with legal recreational cannabis sales had significantly lower prevalence of driving after cannabis use and higher prevalence of protective attitudes compared to those from states without legal recreational sales. Risk perceptions were lower for cannabis than alcohol. Conclusions Public health messaging campaigns to reduce driving and riding after cannabis use and to improve attitudes regarding driving after cannabis use are warranted across all U.S. states, regardless of legalization status.

Edible cannabis products have increased in popularity, particularly in jurisdictions that have legalized nonmedical cannabis. Rates of adverse events from cannabis edibles have also increased, in part because of difficulties identifying and titrating tetrahydrocannabinol (THC) levels. The current study tested whether packaging cannabis in separate units enhances consumer understanding of serving sizes.An experimental task was conducted as part of the 2018 International Cannabis Policy Study online survey. Participants were recruited from the Nielsen Global Insights Consumer Panel. A total of 26,894 participants (61.5% female) ages 16-65 years from Canada and the United States were randomly assigned to view a cannabis brownie packaged according to one of three conditions: (a) multiserving edible ("control condition"), (b) single-serving edible, and (c) single-serving edible packaged separately ("unit-dose packaging"). Participants were asked to identify a standard serving based on information on the product label. Logistic regression was used to test the influence of packaging condition on the likelihood of a correct response, adjusting for key covariates.Compared with the multiserving edible control (50.6%), participants were significantly more likely to correctly identify the serving size in the single-serving edible condition (55.3%; adjusted odds ratio = 1.22, CI [1.15, 1.29], p.001) and the unit-dose packaging condition (54.3%; adjusted odds ratio = 1.17, CI [1.10, 1.24], p.001).Packaging in which each product unit contained one dose of THC enhanced consumers' ability to identify how much of a product constitutes a standard serving or dose. Packaging products as individual doses eliminates the need for mental math and could reduce the risk of accidental overconsumption of cannabis.

The Cannabis Act legalized the possession and sale of nonmedical cannabis in Canada on October 17, 2018. Evaluating the impact of cannabis legalization requires a more thorough understanding than is provided by most existing measures of cannabis use. The aim of this study was to pretest a range of cannabis consumption measures used in a population-based survey and to share insights gained in the process. Cognitive interviewing was conducted among 10 cannabis users aged ≥16 years. Comprehension and self-reporting of consumption types and amounts, sources of purchase, and cannabinoid levels were examined. Findings revealed areas for improvement in a number of survey items, including unclear wording and reference images. Identified issues were used to improve the survey for use in the International Cannabis Policy Study. The authors discuss important principles (e.g., use of visual cues, user-selected units, and time frames) that should be adopted when assessing cannabis use in population-based studies.

Selenium represents an essential trace nutrient that is necessary for biological functions. Deficiencies can induce disease, but excess can induce toxicity. Selenium deficiency is a major concern in underdeveloped countries, while also posing as a toxic pollutant in waterways surrounding landfills, agricultural areas, and fossil fuel production sites. We examined the microbiome of selenomethionine (SeMet) fed American alligators (Alligator mississippiensis) at the beginning and end of a 7-week exposure experiment. Alligators were randomly divided into three groups: control and 1000 or 2000 ppm SeMet. DNA from before exposure (oral and cloaca swabs) and post-exposure (oral, cloaca, small & large intestines) sampling were extracted and amplified for bacterial 16 s rRNA. While treatment did not seem to have much effect, we observed a predominance of Fusobacteriaceae and Porpyromonodaceae across all tissue types. Cetobacterium and Clostridium are the most abundant genera as potential indicators of the aquatic and carrion feeding lifestyle of alligators.

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 = 2929) 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.

INTRODUCTION AND AIMS There is little objective market data on the price or potency of legal and illegal cannabis products following recreational cannabis legalisation. DESIGN AND METHODS In the 2 months post-legalisation in Canada (November-December 2018), legal and illegal cannabis retailers were identified from government lists and online directories. The store location, price and Δ9-tetrahydrocannabinol (THC) and cannabidiol levels of dried herb and cannabis cookies were collected from retailer websites or Weedmaps. RESULTS We identified 185 legal retailers (22 online stores, 163 storefronts; 65 government-run stores, 120 private stores) and 944 illegal retailers (791 delivery-only services, 157 storefronts). Relative to legal dried herb, illegal dried herb was lower in price (1 g: $10.23 vs. $11.08, ⅛ oz: $9.37/g vs. $10.88/g, ½ oz: $8.18/g vs. $8.85/g; P

Relatively little evidence exists on the impact of exposure to cannabis marketing, including potential differences between ‘legal’ and ‘illegal’ cannabis markets. The current study examined cannabis advertisement exposure and brand awareness across three jurisdictions: (i) all Canadian provinces immediately prior to legalization, (ii) US states that had not legalized non-medical cannabis (US ‘illegal’ states) as of August 2018, and (iii) US states that had legalized non-medical cannabis (US ‘legal’ states). Data are from Wave 1 of the International Cannabis Policy Study, an online survey conducted from August 27–October 7, 2018. The current sample (n = 26,710) included respondents from Canada (n = 9840), US illegal states (n = 9578), and US legal states (n = 7292). Regression models were fitted to examine cannabis advertisement exposure and brand awareness. Exposure to cannabis advertising and brand awareness differed across jurisdictions. Respondents in US legal states were more likely to report noticing advertisements, while those in Canada were more likely to report higher brand recall. Across jurisdictions, social media was cited among the most frequent channels from which cannabis advertisements were noticed in the past month. Higher rates of advertisement awareness and brand recall were also associated with greater frequency of cannabis use and self-reported proximity to cannabis retail stores. Results from this study indicate that advertisement exposure was higher in legal cannabis markets, although brand awareness for cannabis products was low across all jurisdictions. The findings reflect the relative novelty of legalized cannabis markets and provide a benchmark for evaluating the impact of cannabis advertising as legal markets become established.

Recreational or 'non-medical cannabis' has been legalized in several US states, and was legalized federally in Canada in October 2018. There is little comparative data on product use across jurisdictions, particularly with respect to the types of cannabis products used, which differentially impact health.Data are from Wave 1 of the International Cannabis Policy Study, collected from Aug 27-Oct 7, 2018. Respondents (n = 27,024) aged 16-65 completed an online survey measuring patterns of cannabis use, quantities and routes of administration. Respondents were recruited from Canada (n = 9976) and US states that had (n = 7362) and had not (n = 9686) legalized non-medical cannabis ('legal' and 'illegal' states, respectively).Prevalence of at least daily, weekly, and monthly cannabis use were significantly higher in US 'legal' states (11.3%, 18.2%, 25.0%, respectively) than US 'illegal' states (7.4%, 11.6%, 16.8%, respectively; p0.001) and Canada (8.9%, 14.1%, 19.0%, respectively; p ≤ 0.01). Dried herb was the dominant form of cannabis reported by past 12-month users across all jurisdictions (77.7%-80.8%). Although the amount of dried herb used per year did not differ by jurisdiction (range: 210.3-229.4 g), those in US 'legal' states were significantly more likely to use dried herb daily or weekly than were those in 'illegal' states and Canada (p0.001). Use of cannabis concentrates, vaped oils, edibles, and drinks was more prevalent among US 'legal' states than 'illegal' states and Canada (p ≤ 0.001). Vaping dried herb was more common in both legal and illegal US jurisdictions than in Canada (p0.05), whereas Canadians were more likely to smoke dried herb with tobacco (p0.001).The prevalence of cannabis use-and use of products such as cannabis concentrates, edibles and drinks-was higher in US states that had legalized cannabis. Additional longitudinal research is required to determine whether these differences reflect causal effects of legalization or pre-existing secular trends.

Canada implemented 'plain packaging' regulations and rotating health warnings for cannabis products upon legalizing non-medical cannabis in October 2018. Plain packaging and health warnings are effective policy measures for reducing appeal of tobacco products; however, there is little evidence in the cannabis domain.An experimental task was conducted as part of the online International Cannabis Policy Study. Participants aged 16-65 from Canada (n = 9987) and US states with 'legal' (n = 7376) and 'illegal' (n = 9682) recreational cannabis were randomly assigned to see one of 18 cannabis product images. Outcomes were product appeal (0 = Not at all appealing, 10 = Very appealing) and perceived youth orientation (4 age groups). A 3 (branding: full branding, brand logo only, or plain black packaging) x 2 (health warning labels: present or absent) x 3 (product type: edible gummies, cannabis oil, or pre-rolled joints) factorial design was used.Compared to plain packaging or a brand logo, packages with full branding were considered more appealing and more likely to be youth-oriented (p 0.001). Products with health warnings were considered less appealing than packages without warnings (p 0.001). Edible gummies were perceived as more appealing and more likely to be youth-oriented than pre-rolled joints and cannabis oil (p 0.001). Additionally, edible gummies were rated as significantly more appealing by 16-18 and 19-35-year-olds than by older adults (p 0.02 for all).Comprehensive health warnings and 'plain packaging' regulations may reduce the appeal of cannabis products in a legal market. The results also provide empirical evidence that edible gummies are perceived to appeal to youth.

In jurisdictions that have legalized recreational cannabis, perceptions of the 'legal' market may influence whether consumers transition from illegal retail sources. The current study examined consumer perceptions of legal versus illegal retail sources in 6 US states with legal retail sales as of 2018: Alaska, California, Colorado, Nevada, Oregon, and Washington State.Data are from Wave 1 of the International Cannabis Policy Study, an online survey conducted in 2018 among 16-65-year-olds. US respondents were asked about cannabis consumption and perceptions of legal cannabis (n = 5530). Multinomial regression models were fitted for each of five consumer perception outcomes.Compared to illegal sources, at least one third of respondents perceived legal cannabis to be higher quality (37.6%) and safer to use (40.3%). More than half reported legal cannabis was more convenient to buy (59.2%) and safer to purchase (56.1%), whereas 30.6% of respondents perceived legal cannabis as more expensive. Perceptions varied according to the length of time since legal cannabis sales began: respondents living in more 'mature' legal markets were more likely to perceive legal cannabis as higher quality (AOR = 1.25, 99%CI = 1.07-1.46, p = 0.0003), less expensive (AOR = 1.20, 99%CI = 1.07-1.35, p 0.0001), more convenient to buy (AOR = 1.36, 99%CI = 1.13-1.62, p 0.0001) and safer to purchase (AOR = 1.21, 99%CI = 1.02-1.44, p = 0.0047).With the notable exception of price, consumers reported generally positive perceptions of the legal cannabis market, with more positive perceptions in US states with more 'mature' legal markets.

Objective This study compared boys’ with girls’ hazard-directed behaviors at home when the mother was present and absent from the room. Methods Videos were coded for how children reacted to a contrived burn hazard (‘Gadget’), maternal verbalizations to children about the hazard, and children’s compliance with directives to avoid the hazard. Children’s behavioral attributes (risk-taking tendency, inhibitory control) and maternal permissive parenting style were also measured. Results Boys engaged in more hazard-directed behaviors when the mother was present than absent, whereas girls’ risk behaviors did not vary with caregiver presence and was comparable with how boys behaved when the parent was absent. Mothers emphasized reactive communications, and boys received significantly more of these than girls. Permissiveness was associated with fewer statements explaining about safety. Children high in inhibitory control showed fewer hazarddirected behaviors and greater compliance with parent communications, whereas those high in risk-taking propensity showed more hazard-directed behaviors and less compliance. Conclusions The hazard-directed behaviors of boys and girls vary with caregiver context, with boys reacting to parent presence with increased risk taking. Depending on child attributes, different supervision patterns are needed to keep young children safe in the presence of home hazards.

Purpose: To explore strategies for disseminating online information about vitamin D to young adults. Methods: Participants were 50 males and females aged 18–25 years, living in Ontario, Canada. Eight focus groups (4 male; 4 female) were conducted; participants also completed a socio-demographic questionnaire. Audio files were transcribed verbatim; thematic analysis was used to identify key themes. Results: Thematic analysis revealed that an effective educational intervention geared towards this population should be simple, brief, interesting, personally relevant, credible, and include incentives. Conclusions: Feedback regarding intervention methodology could be used to inform interventions aiming to increase intake of vitamin D or other nutrients among young adults.

OBJECTIVE: Increased consumption of sugar-sweetened beverages has contributed to rising obesity levels. Under Canadian law, calories for pre-packaged foods and beverages are presented by serving size; however, serving sizes differ across products and even for the same product in different containers. This study examined consumer understanding of calorie amounts for government nutrition labels and industry labelling schemes. METHODS: A national sample of 687 Canadian adults completed an online survey. Participants were randomized to view images of Coke® bottles that displayed different serving sizes and calorie amounts. Participants viewed either the regulated nutrition information on the “back” of containers, or the voluntary calorie symbols displayed on the “front” of Coke® products. Participants were asked to determine how many calories the bottle contained. RESULTS: Across all conditions, 54.2% of participants correctly identified the number of calories in the beverage. Participants who viewed government-mandated nutrition information were more likely to answer correctly (59.0%) than those who saw industry labelling (49.1%) (OR=5.3, 95% CI: 2.6-10.6). Only 11.8% who viewed the Coke® bottle with calorie amounts per serving correctly identified the calorie amount, compared to 91.8% who saw calorie amounts per container, regardless of whether information was presented in the Nutrition Facts Table or the front-of-pack symbol (OR=242.9, 95% CI: 112.1-526.2). CONCLUSIONS: Few individuals can use nutrition labels to correctly identify calorie content when presented per serving or using industry labelling schemes. The findings highlight the importance of revising labelling standards and indicate that industry labelling initiatives warrant greater scrutiny.

Objective To examine longitudinal trends in use of nutrition information among Canadians. Design Population-based telephone and Internet surveys. Setting and Participants Representative samples of Canadian adults recruited with random-digit dialing sampling in 2004 (n = 2,405) and 2006 (n = 2,014) and an online commercial panel in 2008 (n = 2,001). Main Outcome Measures Sociodemographic predictors of label use, use of nutrition information sources, and nutrient content information. Analysis Linear and logistic regression models to examine predictors and changes over time. Results Food product labels were the most common source of nutritional information in 2008 (67%), followed by the Internet (51%) and magazines/newspapers (43%). The Internet was the only source to significantly increase during the study period (odds ratio=1.39; P trans fat increased significantly in 2006 (odds ratio=1.43; P trans fat on packaged foods. Taste and nutrition were consistently the primary factors guiding food choice. Conclusions and Implications Food product labels and the Internet are nutrition information sources with broad reach. More comprehensive labeling regulations were associated with increased use of labels and nutrient information over time.

A between-groups experiment examined the salience of front-of-package (FOP) symbols. Adults from Canada, the US, Australia, and the UK completed an online survey (n = 11,617). Respondents were randomized to view cereal boxes displaying one of 11 FOP label conditions for &lsquo, high&rsquo, levels of sugar and saturated fat: control (no FOP symbol), red circle, red &lsquo, stop sign&rsquo, magnifying glass, magnifying glass + exclamation mark, and &lsquo, caution&rsquo, triangle + exclamation mark, plus each of these five conditions accompanied by a &lsquo, high in&rsquo, text descriptor. Participants identified the amount of saturated fat and sugar in the product (&lsquo, low&rsquo, /&rsquo, moderate&rsquo, ). Participants were more likely to correctly identify the product as &lsquo, in saturated fat or sugar when shown the stop sign, triangle + exclamation mark, red circle, or magnifying glass + exclamation mark symbols incorporating &lsquo, text (p &lt, 0.01). The magnifying glass was the least effective symbol. The stop sign (37.7%) and triangle + exclamation mark (22.0%) were most frequently selected as the best symbol for indicating high nutrient amounts. Overall, FOP labels with &lsquo, descriptions, red color and intuitive &lsquo, warning&rsquo, symbols (e.g., stop signs, exclamation marks, &lsquo, triangles) were more effective at communicating high levels of nutrients of public health concern in a time-limited environment.

A 47-year-old woman with a history of anemia and deep vein thrombosis presented to the hospital with worsening leg edema despite treatment with warfarin. Initial laboratory results revealed leukopenia, anemia and abnormal liver enzymes. Computed tomography and positron emission tomography scans showed generalized lymphadenopathy. Cultures were negative, and lymph node and bone marrow biopsies were inconclusive. Because her clinical presentation suggested malignancy, 2 distinct regimens of empiric chemotherapy were given. She was also treated with antibiotics and antifungal drugs. After 1 month of hospitalization, the patient died. Her autopsy revealed an invasive fungal infection consistent with aspergillosis but no malignancy. Histologic studies of the lymph nodes revealed reactive inflammation without fungi. Generalized lymphadenopathy is an unusual presentation of aspergillosis, and only a few cases have been reported in patients without predisposing risk factors. These cases had granulomatous inflammation. This case demonstrates that invasive aspergillosis should be considered in patients with diffuse lymphadenopathy.

Background Food consumed outside the home accounts for a growing proportion of the North American diet and has been associated with increased obesity. Purpose To examine the effect of nutrition labeling on menus on awareness, use, and food consumption, including the impact of “traffic light” labeling and adding other nutrients. Methods Blinded, randomized trial with 635 Canadian adults conducted in 2010–2011. Participants ordered a free meal from one of four experimental menus: 1) no nutritional information shown, 2) calorie amounts only, 3) calorie amounts in “traffic lights”, and 4) calorie, fat, sodium, and sugar shown in “traffic lights”. Recall of nutrition information, knowledge of calorie content and nutrient consumption were assessed. Results Participants in the calorie conditions were more likely to recall the calorie content of meals and to report using nutrition information when ordering. The calorie content of meals was not significantly different across conditions; however, calorie consumption was significantly lower among participants in the Calorie-only condition compared to the No information condition (mean = − 96 kcal, p = .048). Conclusions Menu labeling increased awareness and use of nutrition information and reduced consumption. Adding “traffic lights”, fat, sodium, and sugar amounts to menus had little impact compared to calorie-only labeling.

ObjectiveCanadians consume approximately twice the daily Adequate Intake of sodium. The present study examined the efficacy of four types of front-of-package (FOP) sodium labels at influencing consumers’ selection of products lowv. high in sodium.DesignParticipants were randomly assigned to one of five experimental conditions: (i) control condition with no FOP label; (ii) basic numeric FOP label; (iii) numeric FOP label with ‘high’ and ‘low’ sodium content descriptors; (iv) detailed Traffic Light (TL) label with colour coding, content descriptors and numeric information; and (v) simple TL label with no numeric information. Participants were shown pairs of grocery products that varied in sodium content and told they could choose a free sample. Selection of the low-sodiumv. the high-sodium product was the primary behavioural outcome, in addition to ratings of effectiveness, understanding, liking and believability.SettingWaterloo, Ontario, Canada.SubjectsAdults (n430) aged ≥18 years, recruited from community settings.ResultsParticipants in the three FOP conditions with ‘high/low’ sodium content descriptors were significantly more likely to choose the lower-sodium product compared with the control group. The detailed TL label was ranked most effective at helping participants select low-sodium products, and was rated significantly higher than other formats in liking, understanding and believability. Product selection did not differ significantly across sociodemographic groups.ConclusionsFOP labels that include content descriptors may be more effective in helping consumers to select lower-sodium products. TL labels, which incorporate content descriptors and colour coding, should be considered for future FOP labelling initiatives.

Objective To examine comprehension of nutrition labels across sociodemographic groups using a measure of health literacy. Methods Cross-sectional survey of a community sample of adults including an adapted version of the Newest Vital Sign for Canadian Nutrition Facts table on prepackaged grocery products, including numerical conversion questions for calorie content and percent daily value. Results Approximately two thirds of participants were able to correctly identify calorie content and percent daily value from the nutrition label. Participants with higher education and higher income, those aged ≤ 64 years, and those who look at nutritional facts or calories were significantly more likely to estimate the correct calorie content. Participants were significantly more likely to correctly identify percent daily value if they reported higher education, higher income, and white ethnicity. Conclusions and Implications Approximately one third of participants could not comprehend basic information on Canadian nutrition labels. Lower socioeconomic status was associated with poorer performance.

To establish the validity and reproducibility of the dietary component of a mobile vitamin D calculator app.Participants entered their dietary intake into the Vitamin D Calculator app on 3 recording days over 1 month and underwent subsequent 24-hour dietary recalls.There were 50 adults (25 female), aged 18-25 years (mean, 22 ± 2 years). Paired-samples t tests tested for significant differences (P.05) in mean vitamin D and calcium intake between the app and dietary recalls; Bland-Altman plots assessed agreement between the 2 measures. Intra-class correlations and Wilcoxon signed-rank tests assessed reproducibility of intakes estimated by the app. Mean vitamin D (n = 50) and calcium (n = 48) intakes and risk classifications did not differ significantly between the 2 measures (P.05).The Vitamin D Calculator app is a valid classification measure for dietary vitamin D and calcium intake. This tool could be used by the general public to increase awareness and intake of these nutrients.

Background Vitamin D plays a key role in bone health. Consuming adequate vitamin D during young adulthood is important due to the development of peak bone mass; however, many Canadian young adults do not meet vitamin D recommendations. This study aimed to improve knowledge, perceptions, dietary intake and blood concentrations of vitamin D among a sample of young adults. Methods Using a pre-post design, 90 Ontario adults (38 men, 52 women; 18–25 years), were randomly assigned to intervention or control groups. Participants completed a socio-demographic survey, pre-post food frequency questionnaire, and a vitamin D knowledge questionnaire (3 time-points). The intervention group watched a video, received online information and tracked intake of vitamin D using a mobile application for 12 weeks. A sub-sample of participants completed pre-post blood 25(OH)D3 tests. Univariate ANOVA tested pre-post between-group differences in vitamin D intake and status. Repeated-measures ANOVA tested between-group differences in vitamin D knowledge and perceptions across 3 time-points. Results Mean vitamin D intake in the sample increased significantly from pre-test (M = 407, SD = 460 IU) to post-test (M = 619, SD = 655 IU), t(88) = 5.37, p