Background Sugar taxes and front-of-package (FOP) nutrition labelling systems are strategies to address diet-related non-communicable diseases. However, there is relatively little experimental data on how these strategies influence consumer behavior and how they may interact. This study examined the relative impact of different sugar taxes and FOP labelling systems on beverage and snack food purchases. Methods A total of 3584 Canadians 13 years and older participated in an experimental marketplace study using a 5 (FOP label condition) × 8 (tax condition) between-within group experiment. Participants received $5 and were presented with images of 20 beverages and 20 snack foods available for purchase. Participants were randomized to one of five FOP label conditions ( no label ; ‘high in’ warning ; multiple traffic light ; health star rating ; nutrition grade ) and completed eight within-subject purchasing tasks with different taxation conditions (beverages: no tax , 20% tax on sugar-sweetened beverages (SSBs) , 20% tax on sugary drinks , tiered tax on SSBs , tiered tax on sugary drinks ; snack foods: no tax , 20% tax on high-sugar foods , tiered tax on high-sugar foods ). Upon conclusion, one of eight selections was randomly chosen for purchase, and participants received the product and any change. Results Compared to those who saw no FOP label, participants who viewed the ‘high in’ symbol purchased less sugar (− 2.5 g), saturated fat (− 0.09 g), and calories (− 12.6 kcal) in the beverage purchasing tasks, and less sodium (− 13.5 mg) and calories (− 8.9 kcal) in the food tasks. All taxes resulted in substantial reductions in mean sugars (− 1.4 to − 4.7 g) and calories (− 5.3 to − 19.8 kcal) purchased, and in some cases, reductions in sodium (− 2.5 to − 6.6 mg) and saturated fat (− 0.03 to − 0.08 g). Taxes that included 100% fruit juice (‘sugary drink’ taxes) produced greater reductions in sugars and calories than those that did not. Conclusions This study expands the evidence indicating the effectiveness of sugar taxation and FOP labelling strategies in promoting healthy food and beverage choices. The results emphasize the importance of applying taxes to 100% fruit juice to maximize policy impact, and suggest that nutrient-specific FOP ‘high in’ labels may be more effective than other common labelling systems at reducing consumption of targeted nutrients. Electronic supplementary material The online version of this article (10.1186/s12966-019-0799-0) contains supplementary material, which is available to authorized users.

A between-groups experiment examined the salience of front-of-package (FOP) symbols. Adults from Canada, the US, Australia, and the UK completed an online survey (n = 11,617). Respondents were randomized to view cereal boxes displaying one of 11 FOP label conditions for ‘high’ levels of sugar and saturated fat: control (no FOP symbol), red circle, red ‘stop sign’, magnifying glass, magnifying glass + exclamation mark, and ‘caution’ triangle + exclamation mark, plus each of these five conditions accompanied by a ‘high in’ text descriptor. Participants identified the amount of saturated fat and sugar in the product (‘low’/’moderate’/’high’). Participants were more likely to correctly identify the product as ‘high’ in saturated fat or sugar when shown the stop sign, triangle + exclamation mark, red circle, or magnifying glass + exclamation mark symbols incorporating ‘high in’ text (p < 0.01). The magnifying glass was the least effective symbol. The stop sign (37.7%) and triangle + exclamation mark (22.0%) were most frequently selected as the best symbol for indicating high nutrient amounts. Overall, FOP labels with ‘high in’ descriptions, red color and intuitive ‘warning’ symbols (e.g., stop signs, exclamation marks, ‘caution’ triangles) were more effective at communicating high levels of nutrients of public health concern in a time-limited environment.

Increasing price was associated with reduced sugary drink purchases. Enhanced FOP labelling results highlight the need for further research to investigate their potential impact. The study adds empirical support for taxation to reduce sugary drink consumption.

BackgroundThe contribution of beverages to overall diet is of increasing interest to researchers and policymakers, particularly in terms of consumption of drinks high in added sugars; however, few tools to assess beverage intake have been developed and evaluated. This study aimed to evaluate the relative validity of a new online Beverage Frequency Questionnaire (BFQ) among young adults in Canada.MethodsA cross-sectional relative validation study was conducted among young adults aged 16–30 years (n = 50). Participants completed a 17-item BFQ, a 7-day food record (7dFR), and a single-item measure of sugary drink intake. Pearson correlations and paired t-tests were used to evaluate correlation and agreement between the measures for 17 individual beverage categories, total drink consumption, total alcoholic beverage consumption, and two definitions of drinks with excess sugars. Cognitive interviews were conducted to examine participant interpretation and comprehensiveness of the BFQ.ResultsEstimates of beverage intake based on the BFQ and the 7dFR were highly correlated, specifically for the total number and volume of beverages consumed, total alcoholic beverage consumption, sugary drink intake, and each of the 17 beverage categories with 3 exceptions: coffee or tea with sugar or cream, specialty coffees, and hard alcohol with caloric mix. Paired t-tests between the BFQ and the 7dFR indicated that the average reported volume was significantly different only for sweetened fruit drinks. The single-item measure of sugary beverage intake was not significantly correlated with the 7dFR. Cognitive interviewing demonstrated high comprehension levels, and confirmed the appropriateness of the BFQ beverage categories and sizes.ConclusionsOverall, the results suggest that the BFQ performed well relative to a 7dFR and had high usability among this study population, indicating its promise for collecting population-level data on beverage intake, including sugar-sweetened beverages, which are known indicators of diet and health.Electronic supplementary materialThe online version of this article (10.1186/s12937-018-0380-8) contains supplementary material, which is available to authorized users.

Objective This study aimed to test the industry claim that “high in” front‐of‐package (FOP) labeling systems are perceived as harsh and reduce consumers’ control over food choices. Methods Respondents aged 16 to 32 years completed a between‐group experimental task in an online survey (n = 1,000). Participants viewed a beverage with one of four FOP labels (text‐only, octagon, triangle, or health star rating) and rated the label on its “harshness” and whether it made them feel more or less “in control” of their healthy eating decisions. Results Across all label conditions, at least 88% of respondents indicated the symbols were “about right” or “not harsh enough.” At least 93% felt the symbols made them feel “more in control” or “neither less nor more in control.” Participants viewing the health star rating were more likely to rate the symbol as “not harsh enough” and less likely to state that the symbol made them feel “more in control.” Conclusions There was no evidence to support industry claims that consumers perceive “high in” FOP symbols as harsh or as restricting their control. Indeed, most participants reported that the symbols were about the right harshness, and that they increased their control, including “stop sign” FOP symbols similar to those implemented in Chile.