Abstract
OBJECTIVE: To assess student perceptions of traffic-light labels (TLLs) in college cafeterias. DESIGN: Cross-sectional, mixed-methods study. SETTING: One northeastern US college. PARTICIPANTS: A total of 1,294 survey respondents; 57 focus group participants. INTERVENTIONS: Seven-week traffic-light labelling (green = 'nutrient-rich', yellow = 'less nutrient-rich', red = 'more nutrient-rich choice in green or yellow') intervention at two college cafeterias. MAIN OUTCOME MEASURES: Perceptions of TLLs and food labelling; disordered eating behaviours. ANALYSIS: Performed χ(2) analyses to test for differences between pre-intervention and postintervention responses, and between postintervention subgroups stratified by site, gender, weight status and varsity athlete status. Qualitative analysis based on the immersion-crystallization method. RESULTS: In postintervention surveys, 60% found TLLs helpful, and 57% used them a few times a week. When asked whether TLLs increased risk of developing eating disorders, 16% of participants said they did and 47% said TLLs might exacerbate existing eating disorders. In focus groups, some students thought the red 'colour seemed jarring', but the vast majority agreed 'the more nutrition information available, the better'. CONCLUSIONS AND IMPLICATIONS: Students generally supported TLLs, but future college-based interventions should address eating disorder concerns. Labels that incorporate nutrition information and education, and avoid negative messaging or judgment of what students eat, may be more acceptable.