Firstly we will outline participant evaluations, both positive and negative, of MCL. Secondly, we consider how participants used MCL to decide whether to purchase particular foods.
1. Evaluations of 'may contain' labelling
MCL was generally considered preferable when compared to receiving no information regarding the possibility of risk. However, there was extensive evidence that participants discounted the 'may contain' message in a range of ways. The view that MCL was neither credible nor desirable was frequently expressed.
MCL was seen to be important when the food product was considered potentially risky. Under these circumstances the uncertainty of having no information about potential cross contamination was viewed as unsatisfactory.
Even in...even in places like (coffee shop), there's a little note on the sign that says, "This contains nuts," tick. There's not even that in the (supermarket) bakery section. So it would help to have something which says "This may contain nut traces", even though I hate it when it says "may contain". Even that would be better than nothing. (I, M, Severe)
MCL was also seen as positive when compared with the lack of nut warnings evident on foreign products.
But they must be a comfort because that's why I feel nervous about the foreign packaging that doesn't have anything. So even though they might, you know, consciously, you might not really think they're much use, but subconsciously, they're giving you some kind of support. They're like a comfort to you. You feel like, oh, people are checking my food (I, F, Moderate)
MCL may be seen to provide reassurance as it conveys the message that the nut content of food products has been assessed and attended to by the manufacturer.
Most participants however claimed that the 'may contain' message was not a helpful one. There were 4 main ways in which participants discounted the 'may contain' message. First, some considered that it was not possible to avoid all products with MCL and that doing so would result in an unfeasibly limited diet.
I've now become sort of blasé in the millions of things that say because if I didn't eat things that said "may contain traces of nuts" I'd have a very narrow spectrum of food that I could eat (I, M, Severe)
They therefore discounted the 'may contain' message for pragmatic reasons.
Secondly, other participants felt that the motivations of the message source (manufacturers or retailers) are suspect and thus that the message is not to be trusted. The main motivation imputed to such sources was that they were simply trying to avoid any liability should any adverse reactions occur.
I can understand why (the 'may contain' messages) are there, because it's a backside-covering exercise for the manufacturers, because they can say "Well we put it may contain traces of nuts in it, and he died, so it's not our fault". So I can see why they've done it, but it's the over-usage of it - it's the boy who cried wolf syndrome. After a while you just become blasé to it and you just go, "well I'm going to eat it anyway". (I, M, Severe)
If it says "may", I generally trust it and I generally buy it, but ...That's how they cover themselves in the manufacturing process isn't it? (AS, M, Severe)
Interestingly in the second quote above the participant equates trusting MCL with the notion that there is nothing in the product that he should be concerned about. The impact of trust is complex. In the quote below the participant explains that he is disregarding the MCL as, if there really were traces of nuts, the supermarket he shopped in and trusted would warn about this more clearly.
Right... Now, I'd usually be a bit cautious with this kind of stuff, but, being (supermarket name), I actually trust them quite a lot because they'll probably have a breakdown...[on everything they make]. Oh, it says "May contain traces of nuts" but...I think that actually...they're probably just writing that and actually they... Plus, I have had cookies from (supermarket name) before, so I usually know they're fine. I think actually they would go further - if there was a genuine risk of having nuts in, they would go further than saying 'May contain nut traces.'... (AS, M, Moderate)
Thus his trust in the supermarket, along with his experience of the brand, allowed him to discount the veracity of the 'may contain' warning. In the following quote, as the company is trusted, this is taken to mean that where they do label with 'may contain' the inference that there is a real risk is warranted.
I don't know why - I do tend to trust the company if it doesn't put "May contain traces of nut", because so many companies, like (brand name) just chuck that on all their labels, and it makes me then wary of eating it because it says "May contain". (I, F, Mild)
Thirdly, participants also attributed different levels of risk to different variants of MCL and considered that different wordings of 'may contain' justified different avoidance strategies: paying attention to the 'stronger' variant of MCL provided grounds for dismissing the 'weaker' version. The first quote below illustrates how 'may contain nuts' was taken more seriously than 'may contain traces of nut' and in the second quote mention of a specific nut was considered to signal a greater risk.
May contain nuts" is...well, I wouldn't eat it, because that means it could contain nuts. "May contain traces of nuts" is different. (I, F, Moderate)
If it says "May contain traces", I'm okay with that - I'll buy that. But if it says quite specifically "May contain traces of peanut", then I won't buy it, because I think that's the... I feel like - I don't feel so confident I think, because I think that's a little bit too specific, you know? (I, F, Severe)
More specific warnings are read as indicating that there is some particular knowledge about the increased risk of the presence of allergens and participants were more likely to be inclined to take precautionary action accordingly.
Finally there was evidence that nut allergic individuals discounted MCL when they considered them to be implausible. We identified two types of 'implausible discounting': where 'may contain' was located on products that legitimately contained nuts and on products where it was considered impossible that they would contain nuts.
Well, I mean, when you look at...if you look at a packet of peanuts and it says "This product may contain traces of nuts," it just...the whole thing becomes a joke, doesn't it? That's just silly. You can't put on a packet of nuts "May contain nuts". It's a packet of nuts! You know, if you're going to put that, it just...it seems like another tick-box exercise to reach a standard. It's not actually commonsense. (I, F, Moderate)
Well, I just think it's a bit stupid because may contain...well, "ingredients - cannot guarantee..." for like a bottle of lemonade or cherryade or something, is like ludicrous. And they know...they know it's pretty much going to be fine. Yeah, you do kind of ignore them, because you think, if they're just saying that about ingredients on lemonade, maybe that's just going to be the same on ingredients of like a sandwich or something. (I, F, Moderate)
Interestingly the second quote above suggests that the participant uses the extreme case of flawed MCL to warrant the claim that other products with a much greater likelihood of containing nuts, are not going to be problematic. This extreme form of labelling was considered particularly damaging by people with severe allergies for whom ingesting allergens was particularly dangerous and who consequently endeavoured to take MCL seriously. In such situations adding highly implausible 'may contain' warnings was seen as adding insult to injury to people who could not afford to discount them.
2. Using 'may contain' labelling
There was a broad range of behavioural responses to MCL. A minority of participants said they would always avoid foods labelled with 'may contain'. The majority of participants were at the other extreme and ignored 'may contain' labelling when making a decision to purchase a product. Sometimes participants adopted more differentiated approaches.
Avoiding food with 'may contain' labelling
Three participants were clear in their claims that they avoided, and would not eat, products labelled with any variants of 'may contain'. Any indication that nuts could be present led to categorical avoidance of the product.
To me, if it says "may contain", it means that that person who's produced it isn't sure, and if that person isn't sure and cannot guarantee that it is, then I'm not going to take that chance, simple as that (I, M, Severe)
MCL was sometimes linked to anxiety. One younger participant described his lack of confidence in dealing with 'may contain' labelling which had resulted in him being too nervous to try new products since moving away from home. He felt that this had constrained his diet to such an extent that he was no longer eating a balanced diet.
"I hate it when it says "May contain nut traces" because that sentence comes up on pretty much every product, food product. ... I can't walk up to something new and think..... that will be fine, because there's a notice on it which says "May contain nut traces." So that limits what I can try, .. so it's hard to try new things....it's very difficult for me, as an individual, to know what to do basically, you know, how to go about trying new things".
So far, I have to admit, I just haven't tried new things. So far, I've stuck to chocolate muffins, which I can eat, fruit and veg, which is an obvious no nuts, and my parents made me ready-made meals, but I probably go for ready-made meals as well, and just the basics, literally the basics, but I need to obviously expand a bit if I want to...be able to feed myself properly (I, F, Severe).
Sometimes avoidance was linked to having had a reaction to food labelled with a 'may contain' warning. The fact that they had had a reaction to such products made some participants more wary about consuming may contain products in the future - either all 'may contain' products or the specific product category.
I Have you ever had a reaction?
P Yes, once, with one that said "May contain traces of nuts".
I What was that to?
P It was a type of chocolate bar from (supermarket) and I had a reaction to it, even though it just said "may contain", and then I never ate anything that said "may contain" again. (I, F, Severe)
Yeah, I suppose pasta sauces in a jar. That's why I said I don't eat them, because they've got the warning on, "Produced in a factory that contains nuts" or "May contain nuts", but they don't list nuts in the ingredients, so I've risked it, but had a really mild reaction, so that it's not worth the risk.
(I, F, Moderate)
Ignoring may contain labelling
All three methods used in this research provided evidence that many participants ignored MCL in the sense that they sometimes bought and consumed products labelled in this way. Participants justified their decisions to consume products with MCL in a range of ways and this was not systematically linked to the characteristics of participants such as age, gender or severity of allergy. Some participants thought there was almost no risk involved in consuming products with a 'may contain' warning. For these people MCL was equated with non-existent or imperceptible risk.
The Carrot & Coriander (soup) is going cheap, so I think that one...that one will be a good one. I've had this before, so I know that will be fine for nuts. No suggestion that there's any nuts in it anyway. Obviously, it says "May contain nut traces", but it won't, so...! (AS, M, Moderate)
For others the uncertainty MCL signalled was so extensive that taking precautionary action was not warranted and taking a risk was a more preferable approach.
P "This product is made in a factory which also handles nuts." That statement has absolutely no impact on me, because it doesn't tell me what nuts. In a factory? Is it on the line or just the factory? It's a completely useless statement, as far as I'm concerned.
I So what do you do when you see that statement usually?
P I'll just...if it's not in the list of ingredients, I'll just risk it. (PCRT, F, Severe)
Other participants considered that although there could be a contamination risk they were happy to eat the product anyway.
I So what about (supermarket name) Cauliflower Cheese?
P They've actually said "no nuts", so at this point, I'd be going I think I'm fine. The recipe has got no nuts. "Ingredients - cannot guarantee nut-free... I'd eat that.
I Okay, cool. So it's because the recipe thing says no nuts?
P Yeah, there's a conscious thing there that says they haven't got any nuts in this recipe. There's an off-chance that some nuts might have crept in. There's an off-chance a jumbo jet could land on my head, yeah, but... (PCRT, M Severe)
It is noteworthy that such participants accepted that 'may contain' did indicate that the food could indeed contain nuts. The concept of risk, and the importance of running a risk (however small), was prominent here.
The reasoning of other participants involved reference to the potential consequence of having an allergic reaction to nuts. One model that these participants adopted was that they would stop consuming 'may contain' foods as and when they got a reaction.
The day that I eat something with that warning on that sets me off with a reaction will be a really sad day, because it will mean it will rule out a lot of other stuff that I've [been willing] to risk, but so far, touch wood, most things I eat, if ..., rather than being a bag of oranges or whatever, you know, they all have that caveat, so I just have to disregard it. It's like, yeah, I know that - tell me something else, kind of thing. (I, F, Severe)
They'll do. £1.85. These are okay. .... I'm going to keep getting it until I get a reaction, in which case I'll stop! (AS, F, Severe)
An alternative model was that the likely reaction would be minor and of an acceptable magnitude.
Yeah. Most of the time, anything that says "May have traces of nuts", then I...if I really want it, then I'll have it, and to be honest with you, you know, that is so low that I'd need to eat a lot of it for it to make me really sick. (I, F, Severe)
I mean, I think, really, there needs to be a test for this, because...a simple test that they can say that it's contaminant-free or so minimal... And for me as well, because I have this slight reaction that I know I can get away with it, I just have a really uncomfortable day - I sometimes wonder how far it's going to go, but then drink plenty and it seems to go away. I know I can risk it. (I, M, Moderate)
Interpreting 'may contain' labelling
Participants made sense of MCL with reference to different dimensions of the context in which they are managing their allergy. They judged, interpreted and made use of product packaging information in relation to the two broad dimensions of context described below.
Firstly MCL is interpreted against the backdrop of the participant's experience. Previous experience of a product was an important arbiter of how any uncertainty introduced by MCL was interpreted. Previous experience was trusted to ensure future safety. For one participant the 'may contain' warning could be safely ignored in the light of previous - uneventful - consumption.
Regarding these, I will always look on the back. It says "No nuts - cannot guarantee nut-free," and I know that's fine because I've had them before. (AS, M, Severe)
For another participant the experience of the moment, for example being hungry and being in a rush, occasioned a more relaxed approach and 'may contain' products were consumed.
It all comes down to how hungry you are, what a hurry you're in and everything else. You know, like tonight, if I'd gone to get biscuits and I'd looked at the first lot, and then I think, well, just got to, sod it, I can't, you know, I just haven't got the time, and it does come down to time and sometimes you just have to grab things and run the risk, and other times, you just think I won't bother. I think I'm normally in the category of I won't bother. (I. F, Severe)
Personal preferences were also important - participants were more willing to eat foods they liked with a 'may contain' label than those they did not like.
I would say, personally, if I really liked the product, then I would take the risk and eat it. (I, F, Severe)
In this situation the immediate benefits outweighed potential risk of consuming the food.
Secondly, beliefs about particular products or food groups/product categories can affect the interpretation of MCL. For example, 'may contain' warnings were interpreted as more credible and as warranting avoidance, if they were linked to a 'problematic product'.
I And then there's the issue of the "May contain nuts". So, if something said "May contain traces of nuts", do you find that helpful?
P It depends on the product. If it's something like (product name) then it wouldn't be an issue. If it's a cereal, like (product name), and it looks a bit dodgy, then I wouldn't entertain it.
I So does 'may contain' actually help you to make a judgement then or...?
P Yes, on some products. Like (product), no, I would automatically buy, wouldn't be a problem, but on something I wasn't sure of, like these rice bars or whatever, then I wouldn't buy it. (PCRT, M, Severe)
This sometimes meant that the look of the product aroused suspicion or if the participant thought it feasible that the product could contain nuts.
In summary then, although there were circumstances when MCL was seen as valuable, participants discounted its veracity in several ways. Not consuming food with MCL was considered unfeasible in the light of their ubiquity, and the perceived motivations of the source rendered the labels untrustworthy. Labels were interpreted to allow ostensibly weaker versions of the 'may contain' warning to be dismissed and the location of warnings on implausible products was also used to justify dismissal. It was clear that for a few, avoiding all foods with MCL was the preferred option and that not to do so caused anxiety. Most participants however, claimed that they did eat foods with MCL and were prepared to run the risk at least until they had a reaction. Previous experience was trusted to signal future safety and present affective states and preferences also provided justification for consuming foods with MCL.