FDA FOCUS GROUP- 'Sodium Reduction Education"

Appendix II

Sodium Reduction Education

Focus Group Research Project

Draft Moderator’s Guide

November 16, 2010

1. Participant Knowledge and Behavior Relative to Sodium

Today, I want to talk with you about salt or sodium in your diet. The terms salt and sodium are interchangeable, so use whichever you want.

Knowledge

1. To start with, please tell me, what are the sources of salt/sodium in your diet? [Moderator: please write them down on a flip chart]. Which one of these provides the biggest amount of salt in your diet?

2. How much salt/sodium do you consume per day? How can you estimate that? Is that too much, just right, it doesn’t matter? Why do you think so?

3. How much sodium per day is too much? Where did you learn that?

4. Should everybody watch their salt intake or only specific groups of people?

5. What, if any, might be the health consequences from consuming too much sodium? What illnesses, if any, are associated with consuming too much sodium/salt?

6. Who is especially vulnerable to consuming too much sodium? [Probe for: people with heart problems and hypertension, elderly, children, pregnant women, etc.]

7. What are the consequences, if any, of consuming too much salt/sodium by people with no health problems?

Behavior

1. If you wanted to reduce your or your family’s salt intake, where would you start?

2. What do you see as the greatest obstacles to getting you and your family to eat less salt in your diet?

3. What about meals prepared at home? What are the main sources of salt in meals prepared at home? What can you do when you eat at home to eat less salt?

4. How useful are packaged foods you buy at the supermarket in helping you or your family eat less salt in your diet?

5. What about low or reduced-sodium type packaged foods? Are they helpful to you to eat less salt? How do you use them? Do you see any problems or difficulties with these kinds of products in terms of helping you eat less salt in your diet?

6. What about restaurants, fast-food, and food prepared away from home? How do you try to reduce your or your family’s salt intake in these situations? What could be done to make it easier to control salt intake in these contexts? Who could help reduce the amount of salt in these foods? Is there anything that the government might do to be helpful?

2. Sodium Labeling

1. How often, if at all, do you check food labels for sodium/salt content in packaged foods? Is it when you buy the product for the first time or at home?

2. How helpful is the Nutrition Facts label in knowing and controlling sodium intake?

3. What are the typical amounts of sodium in packaged foods?/How much sodium is in packaged foods? What units do they use? Are these amounts provided per package or per serving? Do you ever pay attention to %DV? Do you know what %DV stands for? How much %DV is too much for you? How much would you consider low?

4. What about restaurant foods and food cooked at home? In the absence of a label, how do you know how much sodium these foods contain?

5. What do you think of foods having claims such as: “no salt added”, “no sodium”, “reduced sodium”, etc. Do you ever buy them? If yes, why? If not, why?

3. Sodium And Food Manufacturers

1. What are the reasons manufacturers use sodium/salt in packaged foods? [Probe for: taste, as preservative, thickener]

2. Would you like them to put less salt in their products? If yes, why? If not, why?

3. What do you think about who should make the effort in reducing salt/sodium?

4. Participant Reactions to Sodium Reduction Messages

Now, I would like to show you four different statements that are designed to tell people about sodium. After reading each statement I’ll ask you for your reactions.

[Moderator: Present each of the four statements, one at the time in a rotated order between the groups. Each statement will be printed on a separate sheet of paper and needs to be passed to participants one at the time.]

Statement 1 – Health

Eating too much salt has been linked to high blood pressure. This is true for adults, children and even infants. High blood pressure can increase your risk of heart disease or stroke and can be prevented and even lowered by eating less salt and sodium.

Statement 2 – Requirements

A small amount of salt is needed to help certain organs and fluids in your body work properly. Adults should try to eat less than 2,400 milligrams of sodium a day – that’s the same as about 1 teaspoon of table salt. Most Americans eat too much sodium and they may not even know it.

Most of the sodium Americans eat — nearly 80% — comes from processed food. Many processed foods have a high amount of sodium, even when they don’t taste “salty.” Sodium is in many commonly eaten foods such as cereal and bread, cheese, soup, salad dressings and pasta sauces.

Statement 3 – Actions You Can Take

You can help control your salt intake by reading the Nutrition Facts label on food packages. Salt is listed as sodium on the Nutrition Facts label. Select foods that have 5 percent or less % DV for sodium which is low, and limit foods with 20 percent or more of the % DV for sodium which is high. Also, check the serving size on the package – the fewer servings you eat, the less sodium you eat.

Information on the front of the food package can be helpful, too. Look for foods with claims such as "Salt-Fee" (less than 5 mg of sodium per serving), "Low Sodium" (140 mg of sodium or less per serving), or "Reduced Sodium" (at least 25 percent less than the regular product).

• Choose fresh meat, fish, fruit and vegetables over processed foods whenever possible.

• Ask for nutrition information at the restaurant or check on the web before choosing a restaurant.

• Always taste your food first before you add salt – food often contains more than enough salt.

• Use alternatives to salt such as garlic, lemon, pepper, or other spices when added flavor to foods.

• Sauces and salad dressings often contain lots of salt, so ask for them to be served on the side, and then you can control how much you use.

Statement 4 – Policy

To help Americans control the amount of salt they eat, the Food and Drug Administration is asking food companies to lower the amount of salt they put in processed foods. The amount of salt in the food will be lowered gradually over a period of months and years. Some foods may seem a little bland at first but after awhile you won’t notice the difference at all. It takes only a few weeks for your taste buds to get used to having less salt.

1. What is the main take away point of this statement? Could you rephrase it in your own words?

2. What, if anything, in this statement you haven’t heard about? Which particular part(s) of this statement is new to you?

3. Who do you think this statement would work on? Do you see this statement as being relevant to you or your family? If yes, why? If not, why?

4. What, if anything is unclear or hard to understand? What kind of further explanation would you need?

[For Statement 4 on Policy ask the following questions]

1. What do you think about the Government requiring of food manufacturers to put less sodium in their products?

2. Would it change how much you and your family consume? Is there anything you do not like about this idea? Why? [Probe for: worse taste, decreased shelf life, etc]. How would you benefit from this requirement [Probe for: health benefits.]

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