Impact of Sugar-Sweetened Beverage Warning Labels on Consumer Behaviors: A Systematic Review and Meta-Analysis

An, Ruopeng; Liu, Jianxiu; Liu, Ruidong; Barker, Abigail; Figueroa, Roger; McBride, Timothy D.

doi:10.1016/j.amepre.2020.07.003

Cited by 36 publications

(30 citation statements)

References 43 publications

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“…This relative reduction is slightly larger than the approximately 22% relative reduction in a prior trial of text-only warnings using similar methods [ 30 ]. The current trial is in line with meta-analyses that have found that sugary drink warnings reduce selection of sugary drinks [ 10 – 12 ]. The observed reduction in sugary drink purchases and calories from sugary drinks could yield meaningful health benefits at the population level.…”

Section: Discussionsupporting

confidence: 74%

“…Meta-analyses of experimental studies have shown that sugary drink warnings reduce selection of sugary drinks [ 10 – 12 ]. Sugary drink warnings have also been shown to change possible psychological mediators of behavior change, including reductions in both perceived healthfulness of sugary drinks and intentions to consume sugary drinks [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Study predictions came from health behavior theory [ 24 – 27 ], the Tobacco Warnings Model [ 28 ] (an empirical model of how pictorial cigarette warnings exert effects on behavior), as well as prior research on sugary drink warnings [ 10 , 29 , 30 ] and pictorial tobacco warnings [ 13 , 28 , 31 ]. We predicted that parents randomized to pictorial health warnings would be less likely to purchase a sugary drink for their child and would purchase fewer calories from sugary drinks, compared to parents randomized to exposure to a control label.…”

Section: Introductionmentioning

confidence: 99%

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The impact of pictorial health warnings on purchases of sugary drinks for children: A randomized controlled trial

et al. 2022

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Background Pictorial warnings on tobacco products are promising for motivating behavior change, but few studies have examined pictorial warnings for sugary drinks, especially in naturalistic environments. This study aimed to examine the impact of pictorial warnings on parents’ purchases of sugary drinks for their children in a naturalistic store laboratory. Methods and findings Parents of children ages 2 to 12 (n = 325, 25% identifying as Black, 20% Hispanic) completed a shopping task in a naturalistic store laboratory in North Carolina. Participants were randomly assigned to a pictorial warnings arm (sugary drinks displayed pictorial health warnings about type 2 diabetes and heart damage) or a control arm (sugary drinks displayed a barcode label). Parents selected 1 beverage and 1 snack for their child, as well as 1 household good; one of these items was selected for them to purchase and take home. The primary outcome was whether parents purchased a sugary drink for their child. Secondary outcomes included reactions to the trial labels, attitudes toward sugary drinks, and intentions to serve their child sugary drinks. Pictorial warnings led to a 17-percentage point reduction in purchases of sugary drinks (95% CI for reduction: 7% to 27%), with 45% of parents in the control arm buying a sugary drink for their child compared to 28% in the pictorial warning arm (p = 0.002). The impact of pictorial warnings on purchases did not differ by any of the 13 participant characteristics examined (e.g., race/ethnicity, income, education, and age of child). Pictorial warnings also led to lower calories (kcal), purchased from sugary drinks (82 kcal in the control arm versus 52 kcal in the pictorial warnings arm, p = 0.003). Moreover, pictorial warnings led to lower intentions to serve sugary drinks to their child, feeling more in control of healthy eating decisions, greater thinking about the harms of sugary drinks, stronger negative emotional reactions, greater anticipated social interactions, lower perceived healthfulness of sugary drinks for their child, and greater injunctive norms to limit sugary drinks for their child (all p < 0.05). There was no evidence of difference between trial arms on noticing of the labels, appeal of sugary drinks, perceived amount of added sugar in sugary drinks, risk perceptions, or perceived tastiness of sugary drinks (all p > 0.05). Conclusions Pictorial warnings reduced parents’ purchases of sugary drinks for their children in this naturalistic trial. Warnings on sugary drinks are a promising policy approach to reduce sugary drink purchasing in the US. Trial registration The trial design, measures, power calculation, and analytic plan were registered before data collection at www.clinicaltrials.gov NCT04223687.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of pictorial health warnings on purchases of sugary drinks for children: A randomized controlled trial

et al. 2022

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“…Studies that experimentally compare red meat messages to control messages are needed to establish whether characteristics like age, meat consumption, and general perceptions about red meat influence the effectiveness of red meat reduction messages on consumer behaviour. Communication interventions such as product warnings and mass media campaigns that describe the health harms of cigarettes (20,21) , alcohol (22) and sugary drinks (22)(23)(24)(25) have been shown to generate small but meaningful reductions in purchases and consumption of these products, suggesting that communicating about the harms of red meat could help curb red meat intake. We found that both health and environmental harms elicited similar levels of perceived discouragement.…”

Section: Discussionmentioning

confidence: 99%

Awareness of and reactions to health and environmental harms of red meat among parents in the United States

Grummon

Goodman

Jaacks

et al. 2021

Public Health Nutr.

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Objective: Evidence of the health and environmental harms of red meat is growing, yet little is known about which harms may be most impactful to include in meat reduction messages. This study examined which harms consumers are most aware of and which most discourage them from wanting to eat red meat. Design: Within-subjects randomized experiment. Participants responded to questions about their awareness of, and perceived discouragement in response to, eight health and eight environmental harms of red meat presented in random order. Discouragement was assessed on a 1-to-5 Likert-type scale. Setting: Online survey. Participants: 544 US parents. Results: A minority of participants reported awareness that red meat contributes to health harms (ranging from 8% awareness for prostate cancer to 28% for heart disease) or environmental harms (ranging from 13% for water shortages and deforestation to 22% for climate change). Among specific harms, heart disease elicited the most discouragement (mean=2.82 out of 5), followed by early death (mean=2.79) and plants and animals going extinct (mean=2.75), though most harms elicited similar discouragement (range of means, 2.60 to 2.82). In multivariable analyses, participants who were younger, identified as Black, identified as politically liberal, had higher general perceptions that red meat is bad for health, and had higher usual red meat consumption reported being more discouraged from wanting to eat red meat in response to health and environmental harms (all p<0.05). Conclusions: Messages about a variety of health and environmental harms of red meat could inform consumers and motivate reductions in red meat consumption.

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“…Solutions to encourage healthier food purchases in retail settings are urgently needed. Nutrition-related point-ofsale policies and interventions that have shown promise include excise taxes on sugary drinks and ultra-processed food [4][5][6][7]; marketing restrictions [8,9]; and requiring warning labels on sugary drinks and ultra-processed food [9][10][11][12]12]. Most evidence on these policies comes from either real-world observational studies or laboratory-based experimental studies.…”

Section: Introductionmentioning

confidence: 99%

Using a Naturalistic Store Laboratory for Clinical Trials of Point-of-Sale Nutrition Policies and Interventions: A Feasibility and Validation Study

Hall

Higgins

Grummon

et al. 2021

IJERPH

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Point-of-sale policies such as warnings and taxes are promising tools for improving the nutritional quality of food purchases. Research studies conducted in naturalistic store laboratories could improve the quality of evidence about point-of-sale interventions by allowing for realistic exposure in a controlled setting. This study aimed to assess whether purchasing behavior in a naturalistic store laboratory setting was similar to real-life purchasing behavior and to evaluate participants’ perceptions of store realism and the acceptability of research study protocols in this setting. In a longitudinal observational study in 2019, Latinx parents in North Carolina (n = 61) attended five weekly visits at the UNC Mini Mart, a naturalistic store laboratory that resembled a small convenience store. At each visit, participants purchased a week’s supply of beverages. Purchases of beverages in the Mini Mart were compared to participants’ purchases from receipts submitted the week prior to the study. Analyses compared the percentage of participants buying sugary drinks and non-sugary drinks in the Mini Mart vs. in real stores using Chi-Square tests with Fisher’s p. The percentage of parents who purchased sugary drinks in the Mini Mart (93%) was not significantly different from the percentage who purchased sugary drinks during the week before the study (74%, p = 0.28). The percentage purchasing non-sugary drinks was similar in the two settings (85% in the Mini Mart vs. 85% from receipts, p = 0.33). Nearly all participants reported that their Mini Mart purchases were similar to real-life purchases (96%); the Mini Mart felt like a real store (94%); they could find all the beverages they were looking for (92%); and they could imagine doing their real-life beverage shopping in the Mini Mart (92%). Moreover, retention was high, with 97% of participants attending the final study visit. These results indicate that naturalistic store laboratories are a promising method for increasing the ecological validity of trials to evaluate point-of-sale interventions.

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Impact of Sugar-Sweetened Beverage Warning Labels on Consumer Behaviors: A Systematic Review and Meta-Analysis

Cited by 36 publications

References 43 publications

The impact of pictorial health warnings on purchases of sugary drinks for children: A randomized controlled trial

The impact of pictorial health warnings on purchases of sugary drinks for children: A randomized controlled trial

Awareness of and reactions to health and environmental harms of red meat among parents in the United States

Using a Naturalistic Store Laboratory for Clinical Trials of Point-of-Sale Nutrition Policies and Interventions: A Feasibility and Validation Study

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