The Influence of Sugar-Sweetened Beverage Warnings

Abstract

Introduction California, New York, and the cities of San Francisco and Baltimore have introduced bills requiring health-related warning labels for sugar-sweetened beverages. This study measures the extent to which these warning labels influence adolescents’ beliefs and hypothetical choices. Design Participants completed an online survey in which they chose a beverage in a hypothetical vending machine task, rated perceptions of different beverages, and indicated interest in coupons for beverages. Data were collected and analyzed in 2015. Setting/participants A total of 2,202 demographically diverse adolescents aged 12–18 years completed the online survey. Intervention Participants were randomly assigned to one of six conditions: (1) no warning label; (2) calorie label; (3–6) one of four text versions of a warning label (e.g., SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay). Main outcome measures Hypothetical choices, perceptions of beverages, interest in coupons, and endorsement of warning label policies were assessed. Results Controlling for frequency of beverage purchases, significantly fewer adolescents chose a sugar-sweetened beverage in three of the four warning label conditions (65%, 63%, and 61%) than in the no label (77%) condition. Adolescents in the four warning label conditions chose fewer sugar-sweetened beverage coupons and believed that sugar-sweetened beverages were less likely to help them lead a healthy life and had more added sugar compared with the no label condition. Conclusions Health-related warning labels on sugar-sweetened beverages improved adolescents’ recognition of the sugar content of such beverages and reduced hypothetical choices to buy sugar-sweetened beverages.

Impact of warning labels on sugar-sweetened beverages on parental selection: An online experimental study

“…The findings from this study are consistent with evidence regarding the efficacy of aversive images for discouraging unhealthy dietary choices ( Hollands and Marteau, 2016 ; Hollands et al, 2011 ), as well as prior findings of the few studies on the use of warning labels on SSBs ( Lee et al, 2017 ; Bollard et al, 2016 ; Gray et al, 2011 ; Vanepps and Roberto, 2016 ; Roberto et al, 2016 ). The effect size of warning labels overall on SSB selection is similar to that obtained in the previous research based on which this study was powered ( Roberto et al, 2016 ).…”

“…It is worth noting, however, that although the disease image label was rated as less acceptable than other labels, it was considered more acceptable than not having any label. This mirrors recent findings showing support for a policy to place warning labels on SSBs ( Vanepps and Roberto, 2016 ; Roberto et al, 2016 ) and is consistent with evidence that labelling intervention for SSBs are typically better supported by the public, at least compared to more intrusive policies such as taxation ( Gollust et al, 2014 ).…”

“…The findings from a recent simulation study suggest that implementing warning labels, whether text or image-based, on SSBs across all retailers could reduce obesity prevalence among adolescents ( Lee et al, 2017 ). Text-based labels can improve understanding of the health harms associated with SSBs overconsumption and may reduce the selection of such drinks ( Bollard et al, 2016 ; Gray et al, 2011 ; Vanepps and Roberto, 2016 ), including by parents choosing beverages for their children ( Roberto et al, 2016 ). Consistent with prior research on the use of warning labels on tobacco products, image-based labels on SSBs, including labels that illustrate the health consequences of excess sugar consumption ( Bollard et al, 2016 ) and those illustrating sugar content ( Adams et al, 2014 ), appear superior than text-based labels, having been shown more effective at reducing intentions to purchase SSBs and preferences for SSBs ( Bollard et al, 2016 ; Adams et al, 2014 ).…”

Impact of tax and subsidy framed messages on high- and lower-sugar beverages sold in vending machines: a randomized crossover trial

“…Though the effect of an HSR label on consumers’ food and beverage choices was found to be weak in an experimental online scenario [ 21 ] and real-world setting studies [ 22 , 23 ]. The finding that the graphic warning labels might be more effective in changing beverage selection compared to other labels is in line with other online choice scenario studies [ 24 – 26 ]. However, implementation of such warning labels in the real-world setting might be challenging due to strong opposition from the SSB and sugar industries [ 27 , 28 ].…”

Potential unintended consequences of graphic warning labels on sugary drinks: do they promote obesity stigma?

“…More recently, researchers have been investigating whether the use of warning labels could also be effective in reducing sugar-sweetened beverage consumption. Online studies have found that people report lower intentions to choose a sugar-sweetened beverage when a text warning label is presented compared with no warning label (11,12). However, in line with the literature on cigarette smoking, graphic warning labels may be more effective in promoting behaviour change.…”