Background Consumption of sugar-sweetened beverages, including fruit drinks (i.e., fruit-flavored drinks containing added sugar), contributes to childhood obesity. Objectives We aimed to examine whether nutrition-related claims on fruit drinks influence purchasing among parents and lead to misperceptions of healthfulness. Methods We conducted an experiment in a virtual convenience store with 2218 parents of children ages 1–5. Parents were randomly assigned to view fruit drinks displaying one of three claims (“No artificial sweeteners,” “100% Vitamin C,” and “100% All Natural”) or no claim (i.e., control group). Parents selected among each of two drinks for their young child: 1) a fruit drink or 100% juice (primary outcome), and 2) a fruit drink or water. Results When choosing between a fruit drink and 100% juice, 45% of parents who viewed the fruit drink with the “No artificial sweeteners” claim, 51% who viewed the “100% Vitamin C” claim, and 54% who viewed the “100% All Natural” claim selected the fruit drink, compared with 32% in the no-claim control group (all P < 0.001). “No artificial sweeteners” (Cohen's d = 0.14, P < 0.05) and “100% All Natural” (d = 0.15, P < 0.05) claims increased the likelihood of parents choosing the fruit drink instead of water but “100% Vitamin C” did not (P = 0.059). All claims made parents more likely to incorrectly believe that the fruit drinks contained no added sugar and were 100% juice compared to the control (d ranged from 0.26–0.84, all P < 0.001), as assessed in a post-test survey. The impact of claims on selection of the fruit drink (versus 100% juice) did not vary by any of the moderators examined (e.g., race/ethnicity, income; all moderation P > 0.057). Conclusions Nutrition-related claims led parents to choose less healthy beverages for their children and misled them about the healthfulness of fruit drinks. Labeling regulations could mitigate misleading marketing of fruit drinks. Clinical Trial Registry: This trial was registered with ClinicalTrials.gov as NCT04381481.

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ImportanceFruit drinks are widely consumed by young children, and many parents mistakenly believe that these drinks are healthy, potentially due to front-of-package claims and imagery. Research is needed on the influence of this marketing and how labeling regulations could change behavior.ObjectiveTo assess the effects of a front-of-package 100% vitamin C claim, fruit imagery, percentage juice and teaspoons of added sugar disclosures, and high–added sugar warnings on parents’ choices, knowledge, and perceptions of beverages.Design, Setting, and ParticipantsThis randomized clinical trial was conducted May to July 2021 as a single-exposure (no follow-up) online survey of primary caregivers of children ages 0 to 5 years throughout the US.InterventionsParticipants were shown no–, low–, and high–added sugar beverages and asked to choose 1 for their child. Participants were randomized to see high–added sugar beverages with 1 of 7 front-of-package conditions: (1) claim and imagery (control); (2) no claim; (3) no imagery; (4) no claim or imagery; (5) claim, imagery, and percentage juice disclosure; (6) claim, imagery, and warning; or (7) claim, imagery, warning, and teaspoons of added sugar disclosure.Main Outcomes and MeasuresPrimary outcomes were type of beverage chosen (eg, high–added sugar beverage) and resulting calories and added sugar (in grams). Secondary outcomes were fruit drink knowledge (added sugar and percent juice) and perceptions.ResultsThere were 5005 participants included in the final analysis (mean [SD] age, 31.5 [8.3] years; 3587 female participants [71.7%]), including 714 participants in group 1, 717 participants in group 2, 710 participants in group 3, 717 participants in group 4, 708 participants in group 5, 729 participants in group 6, and 710 participants in group 7. Compared with participants in the control group, who had a mean (standard error [SE]) of 9.4 (0.5) g of added sugar and 81.9 (1.6) kcal in chosen beverages, only participants who saw warnings with teaspoons of added sugar disclosures had significantly reduced added sugar (−1.3 g; 95% CI, −2.6 to −0.1 g [−14.2%; 95% CI, −26.7% to −1.8%]; P = .04) and calories (−5.3 kcal; 95% CI, −9.8 to −0.9 kcal [−6.5%; 95% CI, −11.8% to −1.3%]; P = .02) in selected beverages. In warning conditions (ie, 6 and 7) compared with the control group (mean [SE] 41.0% [1.8%]), the proportion of participants choosing high–added sugar beverages was significantly reduced, by 5.5 percentage points (95% CI, 0.5 to 10.5 percentage points [13.4%; 95% CI, 1.2% to 25.6%]; P = .03) and 6.4 percentage points (95% CI, 1.4 to 11.4 percentage points [15.6%; 95% CI, 3.3% to 27.8%]; P = .01), respectively. The no claim or imagery condition (4) significantly reduced the proportion of parents choosing high–added sugar beverages (−7.6 percentage points; 95% CI, −12.6 to −2.6 percentage points [−18.4%; 95% CI, −30.6% to −6.3%]; P = .003). Percentage juice disclosures did not affect beverage choice.Conclusions and RelevanceThese findings suggest that added sugar warnings and prohibitions of front-of-package claims and imagery may reduce parents’ purchases of high–added sugar beverages for their young children but that percentage juice disclosures may not change behavior.Trial RegistrationClinicalTrials.gov Identifier: NCT04811690

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