Developing sugar-sweetened beverage warning labels for young adults

Abstract

Objective: There is a lack of qualitative research developing sugar-sweetened beverage (SSB) warning labels with their intended end-users. We sought to identify promising SSB warning elements for improving label effectiveness and for future testing in policy and institutional settings. Design: Mixed-methods design using 10 focus groups, a design task, and survey. The design task was used to generate ideas for an icon that would dissuade SSB consumption. The survey and focus group guide assessed participant perceptions of SSB warning label mock-ups of text (loss-frame, gain-frame, and loss-frame with attribution), color, and icon options. Setting: Three large public universities in California from February-March 2018. Participants: Young adult SSB consumers (n=86) enrolled in one of three diverse California public universities. Results: Participants perceived the following elements as most effective for reducing SSB consumption: loss-frame text with attribution to a credible source, yellow and red color for label background, and an image or icon to accompany the text. Preferred images included sugar near or inside of an SSB, intuitive shapes like a triangle with exclamation mark or octagon, and a visual indicator of SSB sugar content compared with recommended limits. Support was high for using SSB warning labels in university cafeterias and on bottles/cans. Conclusion: Loss-frame text with a credible source, yellow or red label color, and icons could potentially enhance effectiveness of SSB warning labels and warrant further testing.

“No Child or Adult Would Ever Probably Choose to Have 16 Teaspoons of Sugar”: A Preliminary Study of Parents’ Responses to Sugary Drink Warning Label Options

“…Label shape and use of the signal word, “warning”, facilitated perceptions of seriousness and credibility across all label types similar to previous studies [ 34 , 39 , 40 ]. Consistent with the previously mentioned study of young adults [ 40 ], comparisons were drawn with government tobacco warnings, stop sign shapes and danger warnings.…”

“…These studies have explored reactions to a broader range of potential warning labels on SSBs. The mixed-methods US study of college students’ (n = 86) perceptions of a range of potential SSB warnings (on-product and point of sale) found for text-only messages, attribution to the college health centre increased perceived effectiveness by increasing credibility [ 39 ]. Brevity and clarity of the messages were valued, as were warnings with a picture/icon.…”

Text Messages to Curb Sugar-Sweetened Beverage Consumption among Pregnant Women and Mothers: A Mobile Health Randomized Controlled Trial

“…In our prior qualitative research, pregnant women and parents of infants identified graphic warning labels as the preferred option to motivate SSB reduction for themselves and their infants [24]. Similarly, a mixed-methods study found that young adults perceived warning labels with graphics or icons to be more effective and preferable to text-only labels [49].…”

Is evoking fear effective? Exploratory findings from a randomised experiment on the impacts of health warning labels on sugar-sweetened beverages

“…Our findings also support the idea that effective HWL are often less acceptable ( 16 , 17 ) . Nevertheless, SSB warning labels with loss-frame messages, promoting messages similar to the HWL used in this study, have been proven more effective than gain-frame messages ( 33 ) . Therefore, instead of avoiding such graphic HWL, the task at hand, perhaps, is to discover ways of increasing HWL acceptance, for instance, by complementing it with effectiveness information ( 27 ) .…”