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Objectives To examine the association between awareness, understanding and use of the traffic light food labelling policy (TLFL) and educational level in children and adults from Ecuador. Methods Data from the National Health and Nutrition Survey (ENSANUT) 2018 (40,938 participants aged 10y–98y) was used. Awareness, understanding and use of TLFL were ascertained with the questions ‘do you know/have you seen the TLFL in foods? [yes/no]’; ‘do you understand the TLFL in foods’ [yes/no]; and ‘do you consider that the TLFL helps you with food purchase decisions? (a little or nothing [reference]/some/a lot)’, respectively. Education was categorized as illiterate [reference]; primary school [incomplete/complete]; high school [incomplete/complete]; and higher education. Age, sex, residence (rural/urban), income, poverty index (unsatisfied basic needs) were included as potential confounders. Adjusted multivariable regressions were used to investigate the association of TLFL and education (reported as odds ratios [OR] and 95% confidence intervals [95%CI]), using sampling weights, and Akaike's Information Criterion to select the most optimal models. Results 31,028 participants (79%) reported to be aware of the TLFL, of whom 88% said they understood. Amongst the latter, only 21% reported to use TLFL when purchasing foods. Increasing education was associated with increased odds of awareness and understanding of TLFL (p-values: 0.004, 0.005, respectively) but not with its use. Compared to the lowest education, those with the highest educational level had the highest odds of being aware of and understanding the TLFL, OR 1.54 (95% CI 1.48; 1.61) and OR 1.28 (95% CI 1.19;1.39), respectively. Conclusions Whilst awareness and understanding of TLFL is relatively high in the Ecuadorian population, its use remains low. These findings highlight the need to strengthen public health policies that increase the use of food labelling as reference to make healthier decisions about food purchase, particularly amongst individuals from more vulnerable educational and socio-economic background. Funding Sources AR is funded by an MPH Fellowship and FDCM by a Grant for Research, both awarded by the Fulbright Commission; GMG is funded by COLCIENCIAS (Fondo para Investigacion en Salud -FIS-).

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Awareness, Understanding and Use of the ‘Traffic Light’ Food Labelling Policy and Educational Level in Ecuador – Findings from the National Nutrition Survey 2018