Use Patterns and Behavioral Determinants of Synthetic Food Colorant Use in Urban Pakistani Households: A Qualitative Study

South Asian families have been using synthetic food coloring in their daily and festive meals to make them visually appealing, despite its documented link with allergic, gastrointestinal, and neurobehavioral outcomes. There is limited qualitative literature available in Pakistan about the drivers of the practice at the household level. Objectives: To investigate the reported use practices and perceived factors influencing the consumption of synthetic food colorants among urban, peri-urban, and rural-adjacent Pakistani households. Methods: The study employed a qualitative exploratory-descriptive design, and 30 home cooks were purposively sampled from urban (city centers with population density >1,000 persons/km²), peri-urban (areas at the urban periphery with mixed land use), and rural-adjacent (villages within 10 km of urban centers) areas of Lahore, Karachi, and Islamabad. Semi-structured interviews and field notes were taken and analyzed using Braun and Clarke's reflexive thematic analysis. Results: Four themes were found i.e. (1) the Aesthetic Imperative, where vivid color is associated with food quality and social acceptability, (2) the Intuitive measure, a natural, unmeasured, intergenerationally transmitted dosing practice; (3) the Natural Barrier, involving cost, time, and sensory barriers of natural alternatives; and (4) Cognitive Dissonance and Risk Minimization, a simultaneous awareness and rationalized dismissal of health risks. Conclusions: Continued reliance on synthetic food dyes in households is not a lack of knowledge in urban Pakistan, but it is a culturally embedded and socially reinforced practice, and needs context-sensitive nutrition education, cost-friendly natural alternatives, and intensive regulatory enforcement.