Online Study of the Effects of Sugary Drink Warning Labels on Consumption

Not Applicable

Completed

Conditions: Food Preferences

Interventions: Behavioral: Exposure to calorie information
Behavioral: Exposure to sugar-sweetened beverage warning labels

Registration Number: NCT05079477

Lead Sponsor: University of Pennsylvania

Brief Summary: The aim of this study is to determine the degree to which sugar-sweetened beverages (SSB) warning labels increase consumers' knowledge about the potential health harms of SSBs and reduce SSB purchases and consumption. 216 racially and ethnically diverse parents of children 6-11 years old will be recruited to buy snacks and beverages for four weeks via an online store that ships participants their purchases. Participants will be randomized to either 1) calorie labels (control); or 2) sugar graphic warning labels. The investigators hypothesize that sugar graphic warning labels displayed in an online store in weeks 2-4 will lead to the greatest reductions from week 1 across both primary outcomes compared to the control group that will only see calorie labels.

Detailed Description: During this study, participants will shop in an online store created using Shopify for four weeks. In this within-participant design, the first week of shopping is baseline. Participants will then be randomized to different store interfaces for the remaining three weeks based on one of two warning label conditions: 1) calorie labels (control); or 2) sugar graphic warning labels. Participants will complete a brief survey at the start of the study to assess demographic information, information about parent and child beverage consumption, and their online shopping experiences. At the end they will complete another survey about their beverage consumption, their experience shopping in the store, whether they noticed and used the warning labels, and their ability to recall the warning label message. Participants will also be asked about their perceptions of a specific type of warning label in this final survey. Upon completion of the survey, participants will be shown a debriefing statement explaining the study purpose. After they read the information, they will be asked whether or not they consent to allow their data to be used in this study.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 216

Inclusion Criteria

a primary caregiver of a child 6-to-11 years old;
>=18 years old;
can read and speak English;
primary grocery shopper for their household;
have regular Internet access; and
report that the oldest of their children between 6 and 11 years old is consuming sugar sweetened beverages at least twelve times per month or approximately three times a week

Exclusion Criteria

not a primary caregiver of a child 6-to-11 years old;
<18 years old;
cannot read and/or speak English;
not the primary grocery shopper for their household;
does not have regular Internet access; and
does not report that the oldest of their children between 6 and 11 years old is consuming sugar sweetened beverages at least twelve times per month or approximately three times a week

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Calorie label	Exposure to calorie information	Calorie label (control) will display a calories per package label on all beverages, not just sugary drinks. This is modeled after the American Beverage Association's current "Clear on Calories" labels. Additionally, all snack items will have a calories per serving label.
Sugar graphic warning label	Exposure to sugar-sweetened beverage warning labels	All products in this arm will also have calorie labels. Beverages with added sugar will also have sugar graphic warning labels with the text: "WARNING: drinking beverages with added sugars contributes to obesity, diabetes, and tooth decay" along with graphics depicting the amount of sugar in the beverage.
Sugar graphic warning label	Exposure to calorie information	All products in this arm will also have calorie labels. Beverages with added sugar will also have sugar graphic warning labels with the text: "WARNING: drinking beverages with added sugars contributes to obesity, diabetes, and tooth decay" along with graphics depicting the amount of sugar in the beverage.

Primary Outcome Measures

Name	Time	Method
Beverage Added Sugars Purchased, Week 1	one week	Beverage grams of added sugars/100mL purchased. Number of servings per item and number of items per package varied by product; therefore, added sugar amounts were standardized to grams of added sugar/100mL for beverages.
Beverage Calories Purchased, Week 1	one week	Logged beverage calories/100mL purchased. Number of servings per item and number of items per package varied by product; therefore, calorie amounts were standardized to calories/100mL for beverages.
Beverage Added Sugars Purchased, Weeks 2-4	three weeks	Average beverage grams of added sugars/100mL purchased per week over Weeks 2-4. Number of servings per item and number of items per package varied by product; therefore, added sugar amounts were standardized to grams of added sugar/100mL for beverages.
Beverage Calories Purchased, Weeks 2-4	three weeks	Logged average beverage calories/100mL purchased per week over Weeks 2-4. Number of servings per item and number of items per package varied by product; therefore, calorie amounts were standardized to calories/100mL for beverages.

Secondary Outcome Measures

Name	Time	Method
Volume of Sweetened Beverages Consumed by Child, Baseline	baseline	Ounces of sweetened beverages (labeled in sugar condition) consumed per day in the last month by the child as measured by the Beverage Intake Questionnaire (BEV-Q) parent self-report survey.
Total Added Sugars Purchased, Week 1	one week	Summed grams of beverage and snack added sugars purchased
How Much do You Trust the Information on This Label	Week 4	"How much do you trust the information on this label?". Responses will be measured with a 7-point Likert scale where 1=Not at all and 7=Extremely. Higher numbers indicate greater trust in the label.
Noticing the Label	Week 4	Participants will respond "yes," "no," or "I don't know" to the item: "When you selected a beverage to purchase in the store, did you notice any labels on the beverages other than calorie information?"
Perceived Label Influence	Week 4	Participants will respond: "yes", "no," or "I did not notice any labels" in response to the question of whether the label influenced their purchase.
Likelihood of Label Changing Thoughts	Week 4	"If this government warning label were on a beverage, how much would it change your thoughts about the healthiness of that beverage for your child?" Responses will be measured with a 5-point Likert scale where 1=Not at all and 5=A lot. Higher numbers indicate the label would be more likely to change perceptions of beverage healthiness.
Negative Reactions to the Label	Week 4	Average negative emotional response to the label will be examined (said the warning label made them feel worried, fearful, guilty, or disgusted or grossed out). Responses will be measured with a 5-point Likert scale averaging across the 4 negative emotions where 1=Not at all and 5=Extremely. Higher numbers indicate more negative reactions.
Child Enjoyment of Orange Juice	Week 4	"How much do you think your child would enjoy this product?" Responses will be measured with a 7-point Likert scale where 1=Not at all and 7=Extremely. Higher numbers indicate greater enjoyment of the product.
Number Purchasing a Sweetened Beverage, Week 1	one week	Number of parents buying a sweetened beverage within each condition
Number Purchasing a Sweetened Beverage, Weeks 2-4	three weeks	Number of parents buying a sweetened beverage at any point during Weeks 2-4, within each condition
Total Calories Purchased, Weeks 2-4	three weeks	Log of the average summed beverage and snack calories purchased per week over Weeks 2-4
Volume of Sweetened Beverages Consumed by Parent, Baseline	baseline	Ounces of sweetened beverages (labeled in sugar condition) consumed per day in the last month by the parent as measured by the Beverage Intake Questionnaire (BEV-Q) self-report survey.
Encourage You to Give Fewer Beverages to Your Child	Week 4	"If you saw this government warning label on a beverage, would the label encourage you to serve your child that beverage less often?" Responses will be measured with a 5-point Likert scale where 1=Definitely no and 5=Definitely yes. Higher numbers indicate greater likelihood of serving unhealthy beverages less often.
Likely to Serve or Buy Water	Week 4	"How likely are you to serve or buy this product for your child in the next 4 weeks?" Responses will be measured with a 7-point Likert scale where 1=Not at all and 7=Extremely. Higher numbers indicate greater likelihood of serving or buying the product for their child.
Health Beliefs and Risk Perceptions Index for Water	Week 4	Summed responses to the following 7 health perception questions, 6 of which are prompted with the statement "Drinking this product often would...". The statements end with the following health belief and risk perception language: "lead my child to gain weight," "increase my child's risk of heart disease," "increase my child's risk of diabetes," "make my child feel energized," "help my child focus at school", and "help my child live a healthy life." The other item is: "How healthy do you think this product is for your child?" Responses to questions about weight gain, heart disease, and diabetes will be reverse coded, so higher scores on the summed index will indicate a stronger positive health perception of the beverages. This index ranges 7 to 49.
Volume of Sweetened Beverages Consumed by Parent, Final	Week 4	Ounces of sweetened beverages (labeled in sugar condition) consumed per day in the last month by the parent as measured by the Beverage Intake Questionnaire (BEV-Q) self-report survey.
Snack Calories Purchased, Week 1	one week	Logged snack calories/100g purchased. Number of servings per item and number of items per package varied by product; therefore, calorie amounts were standardized to calories/100g for snacks.
Snack Calories Purchased, Weeks 2-4	three weeks	Logged average snack calories/100g purchased per week over Weeks 2-4. Number of servings per item and number of items per package varied by product; therefore, calorie amounts were standardized to calories/100g for snacks.
Snack Added Sugars Purchased, Weeks 2-4	three weeks	Average snack grams of added sugars/100g purchased per week over Weeks 2-4. Number of servings per item and number of items per package varied by product; therefore, added sugar amounts were standardized to grams of added sugar/100g for snacks.
Total Calories Purchased, Week 1	one week	Log of the summed beverage and snack calories purchased
Child Enjoyment of Sports Drink	Week 4	"How much do you think your child would enjoy this product?" Responses will be measured with a 7-point Likert scale where 1=Not at all and 7=Extremely. Higher numbers indicate greater enjoyment of the product.
Likely to Serve or Buy Orange Juice	Week 4	"How likely are you to serve or buy this product for your child in the next 4 weeks?" Responses will be measured with a 7-point Likert scale where 1=Not at all and 7=Extremely. Higher numbers indicate greater likelihood of serving or buying the product for their child.
Likely to Serve or Buy Sports Drinks	Week 4	"How likely are you to serve or buy this product for your child in the next 4 weeks?" Responses will be measured with a 7-point Likert scale where 1=Not at all and 7=Extremely. Higher numbers indicate greater likelihood of serving or buying the product for their child.
Health Beliefs and Risk Perceptions Index for Soda	Week 4	Summed responses to the following 7 health perception questions, 6 of which are prompted with the statement "Drinking this product often would...". The statements end with the following health belief and risk perception language: "lead my child to gain weight," "increase my child's risk of heart disease," "increase my child's risk of diabetes," "make my child feel energized," "help my child focus at school", and "help my child live a healthy life." The other item is: "How healthy do you think this product is for your child?" Responses to questions about weight gain, heart disease, and diabetes will be reverse coded, so higher scores on the summed index will indicate a stronger positive health perception of the beverages. This index ranges 7 to 49.
Estimate of How Many Teaspoons of Added Sugar Are in Water	Week 4	This variable will be measured continuously based on a text box provided to participants. Median teaspoons in each condition will be assessed
Snack Added Sugars Purchased, Week 1	one week	Snack grams of added sugars/100g purchased. Number of servings per item and number of items per package varied by product; therefore, added sugar amounts were standardized to grams of added sugar/100g for snacks.
Total Added Sugars Purchased, Weeks 2-4	three weeks	Average summed grams of beverage and snack added sugars purchased per week over Weeks 2-4
Volume of Sweetened Beverages Consumed by Child, Final	Week 4	Ounces of sweetened beverages (labeled in sugar condition) consumed per day in the last month by the child as measured by the Beverage Intake Questionnaire (BEV-Q) parent self-report survey.
Child Enjoyment of Water	Week 4	"How much do you think your child would enjoy this product?" Responses will be measured with a 7-point Likert scale where 1=Not at all and 7=Extremely. Higher numbers indicate greater enjoyment of the product.
Likely to Serve or Buy Soda	Week 4	"How likely are you to serve or buy this product for your child in the next 4 weeks?" Responses will be measured with a 7-point Likert scale where 1=Not at all and 7=Extremely. Higher numbers indicate greater likelihood of serving or buying the product for their child.
Estimate of How Many Teaspoons of Added Sugar Are in Orange Juice	Week 4	This variable will be measured continuously based on a text box provided to participants. Median teaspoons in each condition will be assessed
Estimate of How Many Teaspoons of Added Sugar Are in Soda	Week 4	This variable will be measured continuously based on a text box provided to participants. Median teaspoons in each condition will be assessed
Child Enjoyment of Soda	Week 4	"How much do you think your child would enjoy this product?" Responses will be measured with a 7-point Likert scale where 1=Not at all and 7=Extremely. Higher numbers indicate greater enjoyment of the product.
Health Beliefs and Risk Perceptions Index for Orange Juice	Week 4	Summed responses to the following 7 health perception questions, 6 of which are prompted with the statement "Drinking this product often would...". The statements end with the following health belief and risk perception language: "lead my child to gain weight," "increase my child's risk of heart disease," "increase my child's risk of diabetes," "make my child feel energized," "help my child focus at school", and "help my child live a healthy life." The other item is: "How healthy do you think this product is for your child?" Responses to questions about weight gain, heart disease, and diabetes will be reverse coded, so higher scores on the summed index will indicate a stronger positive health perception of the beverages. This index ranges 7 to 49.
Health Beliefs and Risk Perceptions Index for Sports Drinks	Week 4	Summed responses to the following 7 health perception questions, 6 of which are prompted with the statement "Drinking this product often would...". The statements end with the following health belief and risk perception language: "lead my child to gain weight," "increase my child's risk of heart disease," "increase my child's risk of diabetes," "make my child feel energized," "help my child focus at school", and "help my child live a healthy life." The other item is: "How healthy do you think this product is for your child?" Responses to questions about weight gain, heart disease, and diabetes will be reverse coded, so higher scores on the summed index will indicate a stronger positive health perception of the beverages. This index ranges 7 to 49.
Perceived Amount of Added Sugar in Orange Juice	Week 4	This variable will be measured with a 3-point ordinal Likert scale with values: 1 = "too little for my child", 2 = "just right for my child" and 3 = "too much for my child". Higher scores indicate beverage is perceived as having too much added sugar.
Estimate of How Many Teaspoons of Added Sugar Are in Sports Drinks	Week 4	This variable will be measured continuously based on a text box provided to participants. Median teaspoons in each condition will be assessed
Perceived Amount of Added Sugar in Water	Week 4	This variable will be measured with a 3-point ordinal Likert scale with values: 1 = "too little for my child", 2 = "just right for my child" and 3 = "too much for my child". Higher scores indicate beverage is perceived as having too much added sugar.
Perceived Amount of Added Sugar in Soda	Week 4	This variable will be measured with a 3-point ordinal Likert scale with values: 1 = "too little for my child", 2 = "just right for my child" and 3 = "too much for my child". Higher scores indicate beverage is perceived as having too much added sugar.
Perceived Amount of Added Sugar in Sports Drinks	Week 4	This variable will be measured with a 3-point ordinal Likert scale with values: 1 = "too little for my child", 2 = "just right for my child" and 3 = "too much for my child". Higher scores indicate beverage is perceived as having too much added sugar.

Trial Locations

Locations (1): University of Pennsylvania
🇺🇸
Philadelphia, Pennsylvania, United States

Online Study of the Effects of Sugary Drink Warning Labels on Consumption

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