Abstract
Objectives
Five U.S. states have proposed policies to require health warnings on sugar-sweetened beverages (SSBs). SSB health warnings reduce intentions to purchase SSBs, but their effect on actual purchasing behavior remains uncertain. We aimed to evaluate the effect of front-of-package SSB health warnings on SSB purchases.
Methods
In 2018, we conducted a randomized controlled trial in a life-size replica of a convenience store located in Durham, North Carolina, U.S.A. Items were sold at real-world prices and included foods, sugar-sweetened and non-sugar-sweetened beverages, and household products. A convenience sample of 400 adult (age ≥ 18) SSB consumers (consume ≥ 12 oz/week of SSBs) were randomly assigned to a health warning arm (SSBs in the store displayed a health warning label modeled after proposed warnings in the U.S.) or a control condition (SSBs displayed a control label). Labels were displayed on the front of SSB containers. Participants selected items for purchase using $10 provided at study start. The primary outcome was SSB calories purchased.
Results
All 400 participants (236 women, 159 men, and 5 transgender people; mean age = 29.0 [SD = 10.3] years) completed the trial and were included in analyses. Control arm participants were less likely to be Hispanic and to have body mass index in the overweight/obese range than health warning arm participants. Participants in the control arm purchased an average of 143.2 calories from SSBs (SE = 9.7), compared to 109.9 calories from SSBs (SE = 9.5) in the health warning arm. In intent-to-treat analyses adjusting for Hispanic ethnicity and overweight/obesity, health warnings significantly reduced SSB purchases (adjusted difference, −32.4 calories; 95% CI, −59.5, −5.2; P = 0.019). SSB health warnings also reduced the proportion of participants who purchased an SSB from 64% to 50% and the number of SSBs purchased from 0.9 to 0.7 beverages. Results were identical in unadjusted analyses.
Conclusions
Brief exposure to health warnings reduced SSB purchases in this naturalistic randomized controlled trial. Implementing policies to require SSB health warnings could discourage SSB consumption.
Funding Sources
Funding for this study was provided by the National Center for Advancing Translational Sciences (NCATS) and by an internal university grant.
Supporting Tables, Images and/or Graphs
Effect of alcohol label designs with different pictorial representations of alcohol content and health warnings on knowledge and understanding of Low Risk Drinking Guidelines: A randomized controlled trial
