“¡Derrame en el Pasillo 5!” (“Spill on Aisle 5!”): Investigating the Transnational Spillover Effect of Front-of-Package Warning Labels Through Food Environment Characterization and Consumer Perceptions in North Carolina Tiendas

Front-of-package warning labels (FOPWLs) are nutrition labels mandated in several Latin American countries to alert consumers when packaged foods contain excessive levels of nutrients of concern. Products with FOPWLs are being imported into the U.S. for sale in "tiendas" (ethnic Latino grocery stores), thereby creating a "spillover effect" that exposes U.S. consumers to the labeling system. This mixed-methods study characterized the presence of FOPWL in tiendas through rapid store audits and assessed tienda shoppers' perceptions towards labels via on-site exit interviews. Audits across five tiendas identified 620 FOPWL-bearing products, concentrated in beverages (46.5%) and chips (42.3%). Interviews (n=13) revealed a pattern of "comparative inference error," in which shoppers inferred that unlabeled products were nutritionally superior to FOPWL-labeled counterparts, even when both products were nutritionally identical. Following the interview, most participants expressed increased intention to engage with FOPWLs while shopping and broadly supported FOPWL implementation in the U.S.