Local-level program planning for health marketing campaigns should be coupled to food environment interventions, as population sodium knowledge and choosing healthy foods remain low in residents of Los Angeles County, California

Introduction: Limited research has assessed population sodium knowledge and food choice after exposure to health marketing and food environment interventions.

Approach: A cross-sectional survey was administered to a sample of Los Angeles County residents who regularly use public transportation and were exposed to recent food environment changes and health marketing focused on sodium reduction. Street intercept surveys were conducted at two central, high volume bus/Metro-rail stops in the region. Participants were required to be a permanent resident, >age 18, speak English or Spanish, and not be pregnant. A series of multivariable logistic regressions were performed to examine the relationships between sodium knowledge and several key variables (e.g., fast food consumption and weight status).

Results: Of 1,032 invited, 706 adults completed the survey (69%). About half were female and Hispanic. A majority was aged 25-44 (34%) and spoke English at home (39%). When asked about daily sodium limit, less than 4% reported within the accurate range (1500-2300 mg). The odds of underreporting the recommended daily sodium limit was 1.6 times higher among participants who ate fast food/restaurant food >15 times per month (referent group: those who ate 0 times). The odds of underreporting sodium content when shown a double cheeseburger meal example was 1.43 times lower among participants who were overweight/obese as compared to those who were not.

Discussion: Results suggest most adults continued to lack knowledge of recommended sodium levels despite public education, affirming the need for complementary changes to the food environment (e.g., nutrient limits, signage, placement, pricing strategies).