Effects of a behavioral and health literacy intervention to reduce sugar-sweetened beverages: a randomized-controlled trial

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

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Traffic-light labels and financial incentives to reduce sugar-sweetened beverage purchases by low-income Latino families: a randomized controlled trial

Public Health Nutrition ◽

10.1017/s1368980018000319 ◽

2018 ◽

Vol 21 (8) ◽

pp. 1426-1434 ◽

Cited By ~ 7

Author(s):

Rebecca L Franckle ◽

Douglas E Levy ◽

Lorena Macias-Navarro ◽

Eric B Rimm ◽

Anne N Thorndike

Keyword(s):

Randomized Controlled Trial ◽

Low Income ◽

Financial Incentives ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Traffic Light ◽

Sugar Sweetened Beverages ◽

Randomized Controlled ◽

Sweetened Beverages

AbstractObjectiveThe objective of the present study was to test the effectiveness of financial incentives and traffic-light labels to reduce purchases of sugar-sweetened beverages in a community supermarket.DesignIn this randomized controlled trial, after a 2-month baseline period (February–March 2014), in-store traffic-light labels were posted to indicate healthy (green), less healthy (yellow) or unhealthy (red) beverages. During the subsequent five months (April–August 2014), participants in the intervention arm were eligible to earn a $US 25 in-store gift card each month they refrained from purchasing red-labelled beverages.SettingUrban supermarket in Chelsea, MA, USA, a low-income Latino community.SubjectsParticipants were customers of this supermarket who had at least one child living at home. A total of 148 customers (n 77 in the intervention group and n 71 in the control group) were included in the final analyses.ResultsOutcomes were monthly in-store purchases tracked using a store loyalty card and self-reported consumption of red-labelled beverages. Compared with control participants, the proportion of intervention participants who purchased any red-labelled beverages decreased by 9 % more per month (P=0·002). More intervention than control participants reduced their consumption of red-labelled beverages (−23 % v. −2 % for consuming ≥1 red beverage/week, P=0·01).ConclusionsOverall, financial incentives paired with in-store traffic-light labels modestly reduced purchase and consumption of sugar-sweetened beverages by customers of a community supermarket.

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Kids SIPsmartER, a cluster randomized controlled trial and multi-level intervention to improve sugar-sweetened beverages behaviors among Appalachian middle-school students: Rationale, design & methods

Contemporary Clinical Trials ◽

10.1016/j.cct.2019.06.011 ◽

2019 ◽

Vol 83 ◽

pp. 64-80

Author(s):

Jamie M. Zoellner ◽

Kathleen J. Porter ◽

Wen You ◽

Phillip I. Chow ◽

Lee M. Ritterband ◽

...

Keyword(s):

Middle School ◽

Randomized Controlled Trial ◽

Middle School Students ◽

Controlled Trial ◽

School Students ◽

Sugar Sweetened Beverages ◽

Randomized Controlled ◽

Sweetened Beverages ◽

Multi Level ◽

Cluster Randomized

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Follow‐up approaches to a health literacy intervention to increase colorectal cancer screening in rural community clinics: A randomized controlled trial

Cancer ◽

10.1002/cncr.32398 ◽

2019 ◽

Vol 125 (20) ◽

pp. 3615-3622 ◽

Cited By ~ 1

Author(s):

Connie L. Arnold ◽

Alfred W. Rademaker ◽

James D. Morris ◽

Laurie Anne Ferguson ◽

Gary Wiltz ◽

...

Keyword(s):

Colorectal Cancer ◽

Randomized Controlled Trial ◽

Health Literacy ◽

Cancer Screening ◽

Rural Community ◽

Controlled Trial ◽

Literacy Intervention ◽

Community Clinics ◽

Randomized Controlled

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Glycemic Control Outcomes Following Three Weeks of Added Sugar-Sweetened Beverages or 100% Fruit Juice: A Randomized Controlled Trial (P12-015-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz035.p12-015-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Sara Rosenkranz ◽

Olivet Martinez ◽

Trevor Steele ◽

Sam Emerson ◽

Brooke Cull ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Young Adults ◽

Glycemic Control ◽

Fruit Juice ◽

Fasting Glucose ◽

Controlled Trial ◽

Fasting Insulin ◽

Sugar Sweetened Beverages ◽

Randomized Controlled ◽

Sweetened Beverages

Abstract Objectives Regular consumption of sugar-sweetened beverages (SSBs) is associated with increased risk for type 2 diabetes mellitus and other obesity-related diseases. Evidence regarding the effect of 100% fruit juice on glycemic control is conflicting, with little research assessing the metabolic effects of SSBs versus 100% fruit juice, particularly in young, healthy individuals. Therefore, the aim of the current study was to determine whether there were differences in glycemic control outcomes following three weeks of added caffeine-free soda, 100% fruit juice, or water in healthy, young adults. Methods In a 3-arm randomized controlled trial, 36 participants (21.2 ± 2.8 yrs) consumed one of three beverages for three weeks: water (W), caffeine-free soda (S), or 100% fruit juice (FJ). At baseline and following the 3-week intervention, participants completed anthropometric (height, weight, waist circumference, body composition via dual energy x-ray absorptiometry) and glycemic control assessments (fasting glucose (mg/dL), fasting insulin (IU/mL), and a 2-hour glucose tolerance test (OGTT)). Following baseline assessments, participants consumed two servings/day (∼710 mL) of their randomized beverage for three weeks, along with their habitual diets. Insulin resistance was calculated using homeostatic model assessment (HOMA-IR). Differences between beverages for glycemic control outcomes were determined using ANOVA. Results Following the 3-week intervention, changes in fasting glucose were not significantly different between beverage conditions (W:4.70 ± 7.57%, S:5.46 ± 9.79%, FJ:4.93 ± 5.32%; P = 0.97), nor were changes in fasting insulin (W:25.77 ± 33.65%, S:15.71% ± 69.84%, FJ:25.86 ± 54.92%; P = 0.88). Changes in HOMA-IR were not different between beverage conditions (P = 0.96) and similarly, 2-hour OGTT revealed no differences between beverage conditions for glucose (P = 0.82) or insulin incremental area under the curve (P = 0.44). Conclusions In healthy, young adults, under free-living conditions, there were no differences in glycemic control outcomes when adding two servings of SSBs as compared to 100% fruit juice for three weeks. Longer-term trials are needed to elucidate the potential differential glycemic control responses to SSBs versus 100% fruit juice. Funding Sources N/A.

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