Food and design in visual communication

1. Development of a Color-Coded Bilingual
Food Label for Low-Literacy Latino Caretakers
LAUREN H A L D E M A N , ~RAFAELPEREZ-ESCAMILLA,'ANN M. FERRIS,' LINDA DRAKE,'
DAVIDHIMMELGREEN,~HARBYB O N E L L O , ~ANIR G O N Z A L E Z , ~SOFIASEGURA-MILL AN,^
IVETTE M E N D E Z , ~ANGELAB E R M U D E Z , ~AND NANCYROMERO-DAZA~
'Department of Nutritional Sciences, University of Connecticut, Storrs, Connecticut 06269;
2Hispanic Health Council, Hartford, Connecticut 06106
ABSTRACT The purpose of this study was to developa bilin-
gual,user-friendly food label (UFFL)for low-literacy audiences.
The UFFL developedwas based on (a) a quantitative and quali-
tative needs assessment of Food and DrugAdministration (FDA)
food label understanding and use, (b) the development of a
UFFL,and (c)a qualitativeevaluation of the UFFL. Subjectscon-
sisted of a convenience sample (N = 150)of low-income Latino
caretakers living in Hartford with children under 6 years of age,
who were recruited &omlocal community agencies.The primary
outcomes measured in this study were food label use,knowledge,
and understanding.Chi-square analyseswere conducted to deter-
mine relationships between subjects' socioeconomic status and
demographic characteristics with food label use, knowledge,and
understanding.Although 96% of respondentswere familiar with
the FDA food label, only 30% used it routinely when grocery
shopping. FDA food label knowledge was positively associated
(pI.05)with younger age,level of education, and being an Eng-
lish speaker.A UFFL was developed that included color coding,
bilingual text, and a shaded Food Guide Pyramid.Results indi-
cated that participants found the UFFL easy to understand.The
UFFL can be used as a nutrition education tool and the method-
ology developed may help food policy makers to improve the
nutrition education value of the FDA food label.
INTRODUCTION
Food labels are found on most food products sold in the
United States.' Thus,food labels have the potential to become
one of the most significant tools for providing nutrition edu-
cation and information to the public.2However, according to
the 1997 American Dietetic Association Nutrition Trends
Survey,only 27% ofAmericans pay close attention to the food
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
This study was funded by the Unlted States Department ofAgriculture Food Stamps
Program and the Storrs Agricultural Experiment Station.
Address for correspondence:Lauren Haldeman,MS.,Deparanent ofNutritional Sciences
(U-17), University of Connecticut, 3624 Horsebarn Road, Storrs, CT 06269;Tel:(860)
486-3010; Fax (860)486-3674;E-mail: LAH96003@UCONNVM.UCONN.EDU.
02000 SOCIETY FOR NUTRITION EDUCATION
label.3Areview of the consumer food label format preference
s t u d i e ~ ~ , ~ ~revealed that middle-class American consumers
prefer more user-friendly food labels (UFFL) that contain
more inf~rmation,~bar graph^,^ numeric format^,^ and color
coding."hese studiesled to the development of the Food and
Drug Administration (FDA) food label and may help us
understand the low use as well as the barriers associated with
consumers' ability to understand the FDA food label.
Both the type and presentation of information in the label
have important effects on comprehension and preference of
label f ~ r m a t . ~ . ~Limited availabilityof reliable food label infor-
mation,' low literacy skills,and a lack ofbasic nutrition knowl-
edge8-loare all barriers to consumer food label use.This may
be attributed to the fact that adequate information about how
to use the food label is not readily available" or written at an
appropriate literacy level.' According to the National Adult
Literacy Survey, over 40 million Americans age 16 and older
have significant literacy needs, and of those with lowest liter-
acy levels,43% live in poverty and 17%receive Food stamp^.'^
The Latino population is of particular concern because it
is experiencing the fastest annual growth rate in the United
States13and often lives under conditions of poverty. Puerto
Ricans, the predominant group in this study, complete an
average of only 8 years of schooling.13
Additionally, according to Contento et al. (1995),14there
are few nutrition education studies that address the Latino
population.Thus, the specific aims of this study were to (a)
assess the FDA food label understandings of low-income
Latino women living in Hartford, Connecticut with children
under 6 years of age; (b) develop a UFFL; and (c) evaluate its
effectiveness using a qualitative approach. Hartford was an
appropriate location to conduct this research as 89% of
Latino caretakers receive food stamps orAid to Families with
Dependent Children (AFDC).I5
METHODS
The methodological strategy for this study (Fig. 1) followed
three steps: (1) a needs assessment consisting of data from a

2. Journal o f Nutrition Education Volume 32 Number 3 May June 2000 153
* Dotted lines indicate studies being conducted at the same time as the food label survey
** 1 Public Health journalist 1 Ph.D. Nutrition (Nutrition education) 1 Ph.D. Nutrition
1 Ph.D. Public Policy 1 Ph.D. candidate (Nutrition) 2 Ph.D.Anthropology
3 Latino Nutrition educators
(N=500)
Figure 1. Methodological strategy used for development of a user-friendly food label.
Food Label Survey
(N= 150) (NW = 12) A-SSESSMENT*
household-to-household food and nutrition knowledge, atti-
tudes, and behaviors (KAB) community survey (N = 500)16;
a food label survey (N = 150);and three focus group sessions
(N = 12 participants)17; (2) UFFL development; and (3) a
qualitative evaluation consisting of a focus group (N = 8 par-
ticipants) and peer review.The KABI6 survey and the three
focus group sessions took place in parallel to the food label
survey,all of which comprised the needs assessment phase of
this study.Therefore, results from the KAB16 survey and the
three focus group sessions17will be used only in support of
the findings from the food label survey.
KAB survey. The KABl6 survey was a household-to-
household community survey of nutrition knowledge, atti-
tudes, and behaviors conducted in five predominantly Latino
neighborhoods in Hartford. Neighborhoods were selected if,
according to census data, at least half of the residents were
Latino. Households that included at least one child 12 years
or younger were selected. Interviewers began interviewing
on a randomly selected street in the center of each neigh-
borhood and then moved to other streets until the sample
size (N = 500) was reached. Respondents were interviewed
in their households by one of three trained bilingual, bicul-
tural interviewers; the interview took approximately 2 hours
to complete.
I
I
I
II
I
Recruitment and interview process. Upon receipt of
the human subjects' consent, interviewers recruited a conve-
nience sample (N = 150) of low-income Latino caretakers
living in Hartford with children under 6 years of age from
existing programs in a local health agency (N = 80), com-
I
II
II
munity programs (Special Supplemental Nutrition Program
forWomen, Infants and Children;Expanded Food and Nutri-
tion Education Program), and area hospitals (N = 33), and
through word of mouth (N = 21), area elementary schools
(N = 12),and flyers (N = 4).Afier obtaining their verbal con-
sent,participants were given an appointment to come to the
local health agency for the interview. All three interviewers
were bilingual/bicultural. Due to the possibility of language
barriers, the survey was available in both Spanish and Eng-
lish and was administered individually by one of three bilin-
gual, bicultural interviewers or the study coordinator. The
interview lasted approximately 15 minutes and upon com-
pletion each participant received a $5.00 incentive and a
packet of nutrition education materials consisting of the
Food Guide Pyramid, information about child nutrition
I I
I I
I I
L-- ------
User-Friendly Food +--------I
PRODUCT
DEVELOPMENT
topics, healthy recipes, and suggestions on how to access food
in Hartford.
For training, all interviewers were required to read the sur-
vey to familiarize themselves with the content,meet with the
Peer Review**
study coordinator to go over interviewing techniques, answer
any questions related to the survey content, and conduct
practice interviews with a community member before begin-
ning the study.
QUALITATIVE
Food label survey. The central part of the needs assess-
ment was the food label survey, which was conducted from
January to June 1997.The development of this survey took
place from October to December 1996 with input from five
expert community nutritionists. It was pretested with
employees of a local health agency, which is a community-
based research and service organization located in the heart
(N = 8) - EVALUATION

3. 154 Haldeman et al./FOOD LABEL FOR LOW-LITERACY LATINO CARETAKERS
of Hartford's Latino community.15 Input from the local
health agency employees was especially important because
many of them come from the Latino community in Hart-
ford. Content validity was assessed by circulating the survey
among nutrition professionals and community members
within the target population. Survey revisions were made
according to the feedback that was received. The survey
included low-income Latino women living in Hartford with
children under 6 years of age and was developed to assess pre-
liminary information on FDA food label knowledge, atti-
tudes, and behaviors.
The food label survey was divided into the following sec-
tions: (1) socioeconomic status and demographic informa-
tion, (2) FDA food label knowledge and use, (3) shopping
habits, and (4)Food Guide Pyramid knowledge.The first sec-
tion of the food label survey consisted of questions relating
to the socioeconomic and demographic characteristics of the
target population. Data about family characteristics, ethnic-
ity, and level of education, as well as economic status, were
collected. Economic status was based on whether the subject
received or was eligible for Food Stamps at the time of the
interview.The second section of the survey asked questions
relating to the importance of food labels to the subjects,
whether they ever learned about the FDA food label, where
they get their information, and if they use the FDA food label
when deciding which foods to buy.
Using four laminated models of FDA food labels con-
taining varying nutrient information, interviewers asked
respondents seven questions that were used to assess the sub-
ject's level of FDA food label knowledge. Respondents were
shown one model FDA food label and asked "How many
servings are in this product?,""What is the percent daily value
for fat in one serving of this product?,""How many servings
of this product would you need to eat to meet your daily
requirement for vitamin A?,""Is this a high-sodium food?
Why?," and "Is this a high-fat food?Why?" Interviewers then
showed the respondents three different model FDA food
labels and asked"Which of these products has the lowest per-
cent daily value for fat in one serving?" and "Which of these
foods would you choose in order to get all of the calcium
your body needs for the day?"
To determine the relevance of nutrition education focus-
ing on the FDA food label among this target population,
questions relating to shopping habits were asked.Specifically,
subjects were asked if the foods they buy were mostly
canned/packaged or fresh. In addition, subjects were asked
what changes to the FDA food label were necessary to
increase their use of the FDA food label.
The last section of the survey focused on questions about
the Food Guide Pyramid. Subjects were asked whether they
had ever seen the Food Guide Pyramid, as well as questions
relating to serving sizes and the recommended number of
daily food group servings.
Focus groups. During the needs assessment phase, three
focus group sessions took place.17These focus group sessions
included assessing general nutrition topics with an emphasis
on the FDA food label and aiding in the development of a
more understandable and meaningful food label.
The focus group participants were recruited from the
existing local health agency programs. In addition, two of the
bilingual/bicultural interviewers for the food label survey
recruited focus group participants from a group of women
who participated in a previous nutrition needs assessment.
Inclusion criteria used for the food label survey were also
used to recruit participants for all three focus groups. The
same participants for focus group 1 (N = 7) were asked back
to participate in the second focus group (N = 6) so that there
could be more continuity in the process. New individuals
(N= 5)were recruited for the third focus group because after
numerous unsuccessful attempts to contact the same indi-
viduals from the first two focus groups, it was necessary to
recruit new participants. Because focus group 2 was a con-
tinuation of focus group 1 and included the same individu-
als, it should be clarified that focus group 1 actually took
place in two sessions.Therefore, focus groups 1 to 3 will be
referred to as focus group sessions (N = 12)rather than three
separate focus groups.
A bilingual/bicultural moderator,the study coordinator,and
a bilingual/bicultural local health agency employee attended
and reached a consensusofkey findlngs at the end of each focus
group. Before each session,a list of questions was developed to
guide the discussion. Each session lasted approximately 90
minutes, was tape recorded, and the bilingual/bicultural local
health agency employee present took written notes.
Product development. All of the data collected from the
food label survey and the focus group sessions served as a
guideline for developing the UFFL. The food label and
KABI6 surveys provided quantitative data regarding what
information this population needed on the FDA food label,
how they felt it should be organized, and whether they
understood how to read/use the FDA food label.The three
focus group sessions17served as a means for gaining a more
in-depth understanding of the barriers for effective FDA food
label use. Participants were asked to state what they would do
to change the FDA food label to make it more useful to
them.Each focus group session built on the previous one.All
of the recommendations given by the participants were used
to make changes to the FDA food label.
The literacy level of the text of the UFFL was evaluated
using the MicrosoftWord@Flesch-Kincaid readability scores.
The Flesch-Kincaid readability score indicated that the user-
friendly food label was written at a second-grade level and
the Flesch reading ease score was between 90 and 100.The
percent daily value ranges used for the color-coded scale to
classify a specific nutrient's contribution to the diet were low
(0%-5%),18medium (6%-9%),high (10%-19%),I9 and very
high (>20%).19
Last,with the guidance of a graphic artist, the UFFL was
designed using the computer programs PageMaker0 and
Illustrator@.

4. Journal of Nutrition Education Volume 32 Number 3 May June 2000 155
Qualitative evaluation of UFFL. A new group of indi-
viduals (N = 8) participated in a fourth focus group (dura-
tion = 90 minutes).The final draft of the UFFL was intro-
duced in this group and participants were asked to compare
the FDA food label and the UFFL and to make suggestions.
Final revisions were made according to these recommenda-
tions.The purpose of this group was to determine if, for this
group, the UFFL was easy to understand.This was done to
test what would happen if a new food label were actually
used in the marketplace. Recruitment and procedures were
similar to those used for the previous three focus group
sessions.17
Once the UFFL was developed, it was circulated among
professionals in the fields of nutrition, public health, and
anthropology. Feedback received from the focus group and
the peer reviewers was then used to further revise the UFFL.
Data analyses. Descriptive statistics and bivariate analy-
ses were conducted using FDA food label use and knowledge
as outcome variables and language, age, education, ethnicity,
and Food Stamp eligibility as independent variables. Analy-
sis was done using the Statistical Program for the Social Sci-
ences forWindows (SPSS).20A two-tailed p value I .05 was
used as criterion for statistical significance.
A content analysisz1of qualitative data was used to ana-
lyze the data from the fourth focus gr0up.A bilingual/bicul-
tural community nutritionist transcribed and translated the
recordings from focus group 4. Once transcribed, the study
coordinator assessed the information for recurrent patterns
and common themes or concepts brought up by different
individuals on more than one occasion.
RESULTS
KAB survey. The majority of respondents were women
(89.0%) approximately 33 years of age who were the moth-
ers of at least one child less than 12 years of age living in the
household. Of all respondents, 90.0% reported being Latino,
96.0% of whom identified themselves as Puerto Rican. Level
of formal education among Latinos was low, with only 32%
graduating from high school. Income level among Latinos
was also low,with 74.0% receiving Food Stamps.With regard
to food labels, 94.0% of Latinos indicated that they were
familiar with them, but only 18% reported always using food
labels when grocery shopping.
Food label survey.
Socioeconomic status and demographics. Respondents for
this survey were female caretakers living in Hartford with, on
average,one to two children 5 years of age or 1ess.M of these
women were Latino, with the majority being Puerto Rican
(89.3%).These women were, on average,28.0 ? 8.7 years and
56.0% spoke only Spanish in the home.Approximately one-
third (34.0%) of the respondents reported having received
their high school diploma or General Educational Develop-
ment (G.E.D.) high school equivalency certificate and 52.7%
had not completed high school. Only 13.3% attended
schooling beyond high school.Thus, this was a low educa-
tion level and low-income population with 84.0% of the
respondents receiving Food Stamps or eligible to receive
Food Stamps at the time of the study.
FDA food label knowledge. When respondents were pre-
sented with the FDA food label, 89.2% reported that they
understood the label information.However, they were unable
to correctly answer specific questions about the information
found on the FDA food label. For instance, the majority of
respondents could not determine how many servings were
in one container (63.8%), the percent daily value for fat in
one serving (53.7%), or how many servings of the product
they would need to eat to meet their daily requirement for
vitamin A (89.3%). When asked to determine whether a
product was high in fat or sodium, a higher percentage of
respondents answered correctly. However, further probing
revealed that the respondents were answering correctly based
on incorrect reasoning. The product food label used for
this line of questioning indicated a food product containing
3 grams of fat and 300 milligrams of sodium per serving.
Although some respondents correctly identified the product
as high in sodium (66.4%) and low in fat (58.1%),the most
frequent reason given for answering this way was that 300 is
larger than 3.
FDAfood label use. Ninety-six percent of the respondents
reported that they had seen the FDA food label and a
majority of them (97.9%) had seen it in the grocery store
or on food cans and packages. However, of those who had
seen it, only 32.7% had ever been taught how to use the
FDA food label. Survey results revealed that little to no
nutrition education on the FDA food label was coming
from media sources (newspapers, television, magazines) or
other easily accessible means.The fact that only a small per-
centage of respondents reported ever having learned about
the FDA food label may help to explain the small percent-
age (29.5%) of respondents who reported looking at the
FDA food label all of the time when they are grocery shop-
ping. Respondents are being exposed to the FDA food label
regularly as 71.3% of respondents reported buying their
groceries most often in cans or packages that contain the
FDA food label. The low level of FDA food label use
among this group is not due to a lack of interest, as over
90% reported a strong interest in learning more about
nutrition and the food label. Respondents' top three rec-
ommendations for increasing their FDA food label use
included making the FDA food label bilingual (65.0%),pro-
viding more education on how to read the label (58.0%),
and making the FDA food label easier to read (47.0%).

5. 156 Haldeman et al./FOOD LABEL F O R LOW-LITERACY LATINO CARETAKERS
Results from the KAB survey16were highly consistent with
these findings.
Food Guide Pyramid. Of those surveyed, 94.7% of the
respondents reported having seen the Food Guide Pyramid.
However,less than half of the respondents were able to cor-
rectly identify the recommended daily number of servingsfor
fruit (44.7%),vegetables (42.0%), dairy (48.0%), meats
(47.3%), and grains (12.7%). Additionally, only 26.7% of
respondents knew the number of fluid ounces in a cup and
only 24.0% knew how many slices of bread were considered
a serving.
Factors associated with FDAfood label knowledge. Bivari-
ate analyses revealed no significant associations between
respondent's language, age, ethnicity, level of education, or
Food Stamp eligibility and whether the respondents looked
at the FDA food label when they were grocery shopping.By
contrast, significant relationships were found between
respondents' level of education, language, and age and their
ability to correctly answer specific questions about the FDA
food label (Table 1).
Product development. The development of the UFFL
was the result of findings from the food label and KAB16sur-
veys, the first three focus group sessions,17and two qualita-
tive evaluations (Table2).The UFFL (Fig.2) was designed as
a nutrition education tool for low-literacy audiences.Its pur-
pose is to provide this target audience with the necessary
information in an easy-to-understand format needed to
Table 1. Factors associated with food label knowledge.
make healthy food selections.Based on the constant and con-
sistent request from focus group participants, the back of the
UFFL (Fig.3) included a set of instructions on how to read
the 1abel.Theinstructionswould be used as an education tool
and would not be on the product.
Qualitative evaluation. The final focus group (N = 8)
began with a brief, general discussion of the FDA food label
(a copy ofwhich was given to each participant). Participants
were able to identify specific information on the FDA food
label. However, there was a general agreement that many
people do not use or understand the FDA food label. Over-
all, there was a positive response to the UFFL. Participants
reported that it was easy to use and understand.
Peer review. One structural change made after receiving
feedback from peer reviewers was with the color-coded
scale.To avoid the "stoplight effect," it was recommended to
change the red to purple to avoid having FDA food label
users think that a red box in front of a nutrient meant that it
was always "bad" for them (i.e.,the "very high" connotation
is very different if a product is high in fadcalories versus cal-
cium or folic acid).
DISCUSSION
It was evident from the food label survey and focus group
session findings that this community required more educa-
tion to effectively use the FDA food label to make healthier
Servings Needed
Servings per unit % DV Fat in One Serving Product with Lowest % for Daily Calcium
(N = 149)* (N = 149)' DV for Fat (N = 146)' Requirement (N = 146)'
% (p Value) % (p Value) % (p Value) % (p Value)
Language
Spanish only
English or EnglishlSpanish
Age
15-1 9 years
20-35 years
2 36 years
School (completed)
c Eighth grade
Some high school
High school1G.E.D
Some college
'Missing data due to (1) skipped clause in survey, (2) one participant unable to read.
** Chi-square analyses +significant at p value < .05.
DV = daily value.

6. Journal of Nutrition Education Volume 32 Number 3 May June 2000 157
Table 2. Justification for changes made to FDA food label.
User-Friendly Food Label Justification
Section I Bilingual information FLS, NAFG
Addition of color-coding scale KAB, FLS, NAFG
Deletion of serving size weight FLS
Use of "servings per unit" NAFG
Inclusion of the "% calories from fat" NAFG
Section II
Section Ill
Changed to "% Daily Need" NAFG
Included color coding to indicate whether a food is low, medium, FLS, NAFG
high or very high in specific nutrient
Removed nutrient weights FLS
No color coding for sugars and dietary fiber FLS, NAFG
Vitamins and minerals are included as two clearly identified groups NAFG
Each vitamin and mineral is color coded NAFG
Removed information on percent daily values for 2000- and 2500- NAFG
calorie-a-day diet and calories per gram
Included Food Guide Pyramid indicating the number of food group FLS, NAFG
servings needed everyday for a 2000-calorie-a-day diet
Included the number of food group servings in one serving of the FLS, NAFG
product both in text and shading
Provided footnotes to explain that % daily need and servings needed FLS, NAFG
everyday are based on a 2000-calorie-a-day diet and to explain the
Food Guide Pyramid shading
Section IV Instructions on how to use FLS, NAFG, FFG
KAB = knowledge, attitudes, and behaviors survey; FLS = detailed food label survey; NAFG I-IV = needs assessment focus group sessions;
FFG = fourth focus group.
food selections.The food label survey did reveal that those
with a lower level of education were less likely to correctly
use the FDA food label.This finding is supported by previ-
ous s t ~ d i e s . ~ . * , ~ ~AS with the food label survey, Levy et al.
(1992)4also found that age was significantly associated with
label comprehension. For this group, information about the
FDA food label needs to be readily accessiblefor them to take
the time to look at it and then to use it. However, to under-
stand the need to first look at the FDA food label and what
exactly they need to be looking for, it is imperative that
nutrition information and education be made readily avail-
able. Interestingly, respondents perceived that they under-
stood the information in the FDA food label; however,when
asked specific questions about it, they were unable to answer
correctly.Therefore, the nutrition information on the UFFL
needed to be written at an appropriate literacy level and in
a format that was easily understandable-thus, the Span-
ish/English version.The enthusiastic request for and accep-
tance of the color coding by the respondents in this study
indicates that this format is culturally appropriate for this
group. It is also likely that the UFFL may be attractive to
other ethnic groups as well. Although the vast majority of
those interviewed were familiar with the FDA food label and
the Food Guide Pyramid, most were not using them effec-
tively to make food selections.According to both the food
label survey and the focus groups,the number one reason for
this is a lack of understanding of the information.With regard
to the FDA food label, this can be attributed to a lack of
appropriate education and information. Guthrie et al.
(1995)1°support these findings and report that lack of nutri-
tion knowledge may be a significant barrier to more wide-
spread effective use of nutrition labeling.
Last, the results of the final focus group indicated a strong
connection between the UFFL and participants' ability to
correctly retrieve information from the label. With the
UFFL, participants were able to correctly identi6 whether a
food was high, medium, or low in a particular nutrient as well
as how many servings of each food group they should con-
sume everyday.The findings from the final focus group sup-
port the need for designing a more UFFL. Ideally, a more
UFFL would not only enable those consumers involved in
this study to make well-informed food selections, it would
also increase their overall use of the FDA food label.
There are some limitations to this study. First, for the pur-
poses of this study,a convenience sample was used. However,
the high consistency of findings between the KAB survey,16

7. 158 Haldeman et al./FOOD LABEL FOR LOW-LITERACY LATINO CARETAKERS
NutritionFactWDatosde Nutricidn
I
Sewing Size = 1 cup Very HlghlMuyAlto
Porci6n = I taza HigWAlto
Sewingsper unit =2 M s d l u ~ l a n o,
Porcionespor unidad =2 Lowmab1
Amount Per 1 CuplCantidad Por 1 Taza
Calorlmd 150 Caloriesfrom Fat/Calorlasde Grasa:70
C8lori8s %Caloriesfrom Fat/% Calorlasde Grasa:47%
I
% Daily Need/% Requerimiento Diario*
FaWOrasa 12%
SaturatedFatIGrasaSaturada 28% I
DietaryFiberffibraDietaria 0961
SugarslAzlicar11g
PmtmlnlPmtmh8 89
VitaminJ Vimin CMtamina C 4%
-
Vitarninrs VitaminA N i i n a A 6% ,
Vitamin DNiimina D U%I
Minonld Calcium/Calcio 30%
'Servings neededeveryday1 "Servings in onecup of this product1
'Porciones requeMasdiariamente "Porciones en unatazade este
pmducto:
Figure2. Front view of the user-friendly food label.

8. Journal of Nutrition Education Volume 32 Number 3 May June 2000
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Figure3. Back view of the user-friendlyfood label.

9. 160 Haldeman et al./FOOD LABEL F O R LOW-LITERACY LATINO CARETAKERS
the food label survey, and the three focus groups" strongly
supports the external validity of these findings.In addition,
the study was limited to Latino women caretakers and did
not address the needs of children or men.
Another study limitation is that this study did not include
an assessment of the knowledge gained or understood
between the FDA food label and the UFFL in this group, and
only a small number of focus groups were conducted for this
evaluation.The positive response to the UFFL may have been
due to the fact that the UFFL was bilingual.A comparison
of use and understanding between the FDA food label and
the UFFL among this group and a more in-depth evaluation
of the effectivenessof the UFFL are areas for future research.
IMPLICATIONS FOR RESEARCH AND PRACTICE
As the development of the FDA food label took in excess of
6 years,the UFFL designed as a product of this study should
not be seen as a replacement for the FDA food label.Rather,
the methodology used to develop the UFFL may be used to
aid the U.S. Department ofAgriculture and the FDA in the
development of an improved food label.
Additionally,nutrition educators can use the UFFL to aid
consumers on how to read the FDA food label and under-
stand conceptsneeded to better use it.The methodology used
in this study can serve as a model for developing other cul-
turally appropriate nutrition education materials.This is par-
ticularly urgent as both the food label survey and the focus
group results revealed a strong need for more culturally
appropriate general nutrition education interventions, as
well as the strong interest this community has in learning
more about nutrition.
ACKNOWLEDGMENT
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