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

Abstract

Sugar-sweetened beverages (SSBs) are one of the largest added sugar sources to diets in the UK and USA, particularly among young people. Warning labels, including calorie information labels, could reduce SSB consumption but uncertainty surrounds the labels that are most effective. This study assessed the impact of labels containing (a) each of two image-based warnings and (b) calorie information, singly and together, on SSB selection by parents of 11–16-year-olds living in the UK. Using a 3 (disease image, sugar content image, no image) × 2 (calorie information, no calorie information) between-subjects experimental design, 2002 participants were randomised to see beverages with one of six labels and selected one for their child to consume. The primary outcome was the proportion of participants selecting an SSB. Data were collected in December 2017. Logistic regressions showed SSB selection was lower when labels contained an image-based warning (35%), compared to not having any label (49%) or just calorie information (43.5%). The disease image lowered selection more than the sugar image (32% vs 40.5%). Providing calorie information with the disease image had no additional impact on selection (33%) but enhanced the impact of the sugar image (36%). Image-based warning labels discourage SSB selection by parents for their children. Images depicting health consequences of excess sugar consumption have larger effects than those depicting sugar content. Calorie information does not add to the effect of the former but does to that of the latter. Field studies are needed to assess the impact of SSB warning labels in real-life settings.

“When we were young, it really was a treat; now sugar is just the norm every day”—A qualitative study of parents’ and young adults’ perceptions and consumption of sugary drinks

“…Simple, front‐of‐pack information about free sugar content would be beneficial to help make this information more readily available to consumers. There is evidence that such labels have the potential to influence SSB consumption . Information is important but SSB consumption, like all health behaviours, is influenced by individual, social and environmental factors.…”

Image-and-text health warning labels on alcohol and food: potential effectiveness and acceptability

“…While studies have investigated the acceptability of drinks displaying image-and-text HWLs [14] to our knowledge no studies have investigated the acceptability of the labels themselves in the context of alcohol. In the context of SSBs, in the UK, image-and-text HWLs were found to be less acceptable than labels depicting sugar content or calorie information [20]. In New Zealand, they were less acceptable than text-only HWLswith 66% support for the introduction of text-only HWLs on SSBs, compared with 50% support for image-and-text HWLs [17].…”

“…For food, text-only HWLs have been shown to decrease intentions to consume and purchase a range of labelled food products [16], and decrease the likelihood of purchasing SSBs [17]. Image-and-text HWLs on food have also been shown to increase dietary self-control in relation to snack foods [18,19], reduce hypothetical selection [17,20], and real-life purchasing of SSBs [21]. Comparing different types of HWLs, image-and-text HWLs are more effective at reducing selection of SSBs than text-only HWLs, nutritional labels [17,21], or labels depicting sugar content [20].…”

“…In addition, disgust has been identified as a key component of the effects of alcohol HWLs on intentions to reduce alcohol intake [23]. In the context of food, negative emotional arousal has been highlighted as a potential mediator of the effects of HWLs on SSB selection [20]. However, the two studies to date that have investigated the effect of food HWLs on negative emotions specifically concern SSBs [20] or were conducted in unrepresentative populations [24].…”

Image-and-text health warning labels on alcohol and food: potential effectiveness and acceptability

“…In addition, disgust has been identified as a key component of the effects of alcohol HWLs on intentions to reduce alcohol intake [23]. In the context of food, negative emotional arousal has been highlighted as a potential mediator of the effects of HWLs on SSB selection [20]. However, the two studies to date that have investigated the effect of food HWLs on negative emotions specifically concern SSBs [20] or were conducted in unrepresentative populations [24].…”