In the 1994 FMI survey (FMI, 1994), two-thirds of shoppers who had seen the new Nutrition Facts box said it was clearer and more understandable than the old box. Kristal and coworkers (1998) reported that significantly fewer people found the label to be confusing, burdensome, and difficult to read after the new format was introduced, but 70 percent of those studied, especially older and less well-educated individuals, still wanted the label to be easier to understand. The main barrier to use of nutrition labeling as reported by Kristal and coworkers (1998) was lack of interest. In a 1995–1996 study, Levy and coworkers (2000) found that the majority of subjects could not define % DV, did not find it useful for assessing the fat content of a product, and did not know how to use it appropriately to select a diet low in fat. Hrovat and colleagues (1994) also reported that 56 percent of 200 volunteers in a small pilot study did not correctly use the % DV, but the researchers acknowledged limitations in the study design.
Since 1973 the Nutrition Facts box or its equivalent has provided consumers with the reliable, objective nutrient composition of the product, the ability to compare products and, increasingly, the ability to place them in the context of a total daily diet. Several studies have attempted to address the larger question of whether the use of nutrition labeling information contributes to overall diet quality. Kreuter and colleagues (1997) found that label users had diets lower in fat and higher in fruits and vegetables than nonusers. In a population-based study in Washington State that was conducted between 1995 and 1996 and in which 80 percent of residents reported reading nutrition information on packaged food, there was a significant association between label reading and fat intake (Neuhouser et al., 1999). Levy and colleagues (2000), however, found a relationship between reported regular use of the label and fat consumption, but no association between understanding of the label and fat consumption. Regardless of an individual’s income, Perez-Escamilla and Haldeman (2002) found label use to be associated with higher scores on the Healthy Eating Index, a measure of diet quality based on the Food Guide Pyramid (Kennedy et al., 1995). In this study those who were more affluent but did not use labels were as likely as less affluent nonusers to have a low Healthy Eating Index.