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

Racial, ethnic, and socioeconomic disparities in childhood obesity in the United States (U.S.) originate in early life. Maternal sugar-sweetened beverage (SSB) consumption is an early life risk factor for later offspring obesity. The goal of this study was to test the effects of policy-relevant messages delivered by text messages mobile devices (mHealth) on maternal SSB consumption. In this three-arm 1-month randomized controlled trial (RCT), pregnant women or mothers of infants in predominantly Hispanic/Latino New York City neighborhoods were randomized to receive one of three text message sets: graphic beverage health warning labels, beverage sugar content information, or attention control. The main outcome was change in maternal self-reporting of average daily SSB consumption from baseline to one month. Among 262 participants, maternal SSB consumption declined over the 1-month period in all three arms. No intervention effect was detected in primary analyses. In sensitivity analyses accounting for outliers, graphic health warning labels reduced maternal SSB consumption by 28 kcal daily (95% CI: −56, −1). In this mHealth RCT among pregnant women and mothers of infants, graphic health warning labels and beverage sugar content information did not reduce maternal SSB consumption.

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Developing sugar-sweetened beverage warning labels for young adults

Public Health Nutrition ◽

10.1017/s1368980021002287 ◽

2021 ◽

pp. 1-24

Author(s):

Jennifer Falbe ◽

Astrid Montuclard ◽

Alina Engelman ◽

Sabrina Adler ◽

Athena Roesler

Keyword(s):

Public Universities ◽

Sugar Content ◽

Warning Label ◽

Warning Labels ◽

Sugar Sweetened Beverage ◽

Design Task ◽

Sweetened Beverage ◽

Institutional Settings ◽

Loss Frame ◽

Credible Source

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.

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