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Miller C, Ettridge K, Pettigrew S, Wittert G, Coveney J, Wakefield M, Roder D, Durkin S, Martin J, Kay E, Dono J. Warning labels for sugar-sweetened beverages and fruit juice: evaluation of 27 different labels on health effects, sugar content, energy and exercise equivalency. Public Health 2024; 230:138-148. [PMID: 38547760 DOI: 10.1016/j.puhe.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Front-of-pack warning labels may reduce consumption of sugar-sweetened beverages, potentially mitigating negative health outcomes. Comparisons between different warning label types to inform future research and policy directions are lacking. This study compared 27 warning labels across six message types for their potential to reduce sugar-sweetened beverage consumption. DESIGN AND METHODS A national sample of regular soda (n = 2578) and juice (n = 1048) consumers aged 14-60 years participated in an online survey. Participants evaluated randomly allocated labels; one from each of six warning label sets (health-graphic, sugar-pictogram, sugar-text, exercise equivalents, health-text, energy information) on four measures of perceived effectiveness (PE: overall effectiveness, discourage from drinking, emotional response, persuasive potential). Participants could also provide open comments. A general linear model compared differences in mean scores across label sets for each measure of PE. RESULTS PE ratings differed significantly between label sets. Labels clearly quantifying sugar content (sugar-teaspoons) received consistently high PE ratings, whereas 'high in sugar' labels did not. Health-graphic labels were rated highly across all PE measures except persuasive potential. Exercise labels only rated highly on persuasive potential. Health-text results were mixed, and energy labels were consistently low. CONCLUSIONS Simple, factual labels were easily interpreted and perceived as most effective. Labels quantifying sugar content were consistently high performers and should be advanced into policy to help decrease overconsumption of sugar-sweetened beverages.
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Affiliation(s)
- C Miller
- School of Public Health, The University of Adelaide, Adelaide, Australia; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - K Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
| | - S Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - G Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute and Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - J Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - M Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - D Roder
- Cancer Epidemiology and Population Health, University of South Australia, Australia
| | - S Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Martin
- Food for Health Alliance, Cancer Council Victoria, Melbourne, Australia
| | - E Kay
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; College of Education Psychology and Social Work, Flinders University, Adelaide, Australia
| | - J Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
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Azaad Moonesar I, Al-Alawy K, Gaafar R. Taxing sugar-sweetened beverages: Knowledge, beliefs and where should the money go? Heliyon 2024; 10:e28226. [PMID: 38638996 PMCID: PMC11024569 DOI: 10.1016/j.heliyon.2024.e28226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 04/20/2024] Open
Abstract
Background The Sugar-Sweetened Beverage (SSB) industry consciously and subconsciously influences consumers to buy its products. Countering unhealthy messaging and behaviour could be tackled through the SSB levy and allocation of revenue toward healthy lifestyle programs. Given the limited information in the UAE on demographic and consumer knowledge and beliefs and allocation of SSB levy, we conducted a study to explore this further. The study objectives were to a) explore the association between demographic factors (nationality, income and education) with knowledge and beliefs for SSB and b) explore participants' views on allocating SSB levy toward healthy lifestyle programs. Methods A cross-sectional study of adults in the United Arab Emirates. Results The findings suggest knowledge was high for Sugar-Sweetened Beverages (SSB), obesity, and diabetes (1,231, 96.1%), and there was a high awareness of SSB tax (1,066, 83.2%). Knowledge and beliefs about Sugar-Sweetened Beverages were statistically significant for two demographic factors. There was support for the tax revenue to be spent on government programs and greater support for spending to be directed toward specific healthy lifestyle programs such as school health programmes (514, 39.8%), children's diet and nutrition programmes (497, 38.5%), physical activity programmes (480, 37.2%), among others. Conclusions The findings shed light on the influence demographic factors have on knowledge and beliefs, public health gaps and potential areas for SSB levy expenditure. Further research is needed to understand how best to implement healthy lifestyle programs within the community to optimise coverage, cost-effectiveness, and health outcomes.
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Affiliation(s)
| | - Khamis Al-Alawy
- Mohammed Bin Rashid School of Government, Dubai, United Arab Emirates
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Falbe J, Musicus AA, Sigala DM, Roberto CA, Solar SE, Lemmon B, Sorscher S, Nara D, Hall MG. Online RCT of Icon Added-Sugar Warning Labels for Restaurant Menus. Am J Prev Med 2023; 65:101-111. [PMID: 37344035 PMCID: PMC10913691 DOI: 10.1016/j.amepre.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION To reduce added-sugar consumption, jurisdictions are considering requiring restaurant menu labels to identify high-added-sugar items. This study examined the impacts of added-sugar warning labels on hypothetical choices, knowledge of items' added-sugar content, and perceptions of high-added-sugar items. STUDY DESIGN The design was an online RCT. SETTING/PARTICIPANTS National sample of adults (N=15,496) was recruited to approximate the U.S. distribution of sex, age, race, ethnicity, and education. INTERVENTION Participants viewed fast-food and full-service restaurant menus displaying no warning labels (control) or icon-only added-sugar warning labels next to high-added-sugar items (containing >50% of the daily recommended limit). MAIN OUTCOME MEASURES The main outcome measures were hypothetical ordering of ≥1 high-added-sugar item, grams of added sugar ordered, and knowledge of items' added-sugar content assessed in 2021 and analyzed in 2021-2022. RESULTS Warning labels reduced the relative probability of ordering ≥1 high-added-sugar item by 2.2% (probability ratio=0.978, 95% CI=0.964, 0.992; p=0.002); improved knowledge of added-sugar content (p<0.001); and led to a nonstatistically significant reduction of 1.5 grams of added sugar ordered, averaged across menus (p=0.07). The label modestly reduced the appeal of high-added-sugar items, increased perceptions that consuming such items often will increase Type 2 diabetes risk, increased perceived control over eating decisions, and increased injunctive norms about limiting consumption of high-added-sugar items (ps<0.001). However, in the warning condition, only 47% noticed nutrition labels, and 21% recalled seeing added-sugar labels. When restricting the warning condition to those who noticed the label, the result for grams of added sugar ordered was significant, with the warning condition ordering 4.9 fewer grams than the controls (95% CI= -7.3, -2.5; p<0.001). CONCLUSIONS Added-sugar warning labels reduced the probability of ordering a high-added-sugar menu item and increased participants' knowledge of whether items contained >50% of the daily value for added sugar. The modest magnitudes of effects may be due to low label noticeability. Menu warning labels should be designed for noticeability. REGISTRATION This study was registered at AsPredicted.org #65655.
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Affiliation(s)
- Jennifer Falbe
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, Davis, California.
| | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Desiree M Sigala
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah E Solar
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, Davis, California
| | - Brittany Lemmon
- Department of Statistics, University of California, Davis, Davis, California
| | - Sarah Sorscher
- Center for Science in the Public Interest, Washington, District of Columbia
| | - DeAnna Nara
- Center for Science in the Public Interest, Washington, District of Columbia
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Howell BL, Skelton JA, Jayaprakash MS, Lewis KH. Staff Knowledge, Attitudes, and Beliefs About Child Sugar-Sweetened Beverage Intake and Acceptability of a Pediatric Clinic-Based Beverage Screener. Comput Inform Nurs 2023; 41:402-409. [PMID: 36076342 DOI: 10.1097/cin.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Beverages are the leading source of sugar in children's diets and a modifiable risk factor for adverse health conditions. Electronic health record-based screeners could facilitate health systems' efforts to reduce child consumption of sugary beverages. Before implementing a sugar-sweetened beverage screener in the electronic health record within academic healthcare system, 228 pediatric and family medicine clinic staff completed an online educational training to familiarize them with the screener and its rationale. Pretraining and posttraining surveys were used to examine the association between staff knowledge of sugar-sweetened beverages and the acceptability of the screening workflow. Respondents displayed high levels of pretraining knowledge about health consequences of added sugar intake, but lower levels of pediatric beverage guideline knowledge. Knowledge improved from pretraining to posttraining surveys, with high acceptability of the screening process. Staff compliance with sugar-sweetened beverage screening was examined using electronic health record data. During the 6 months after screener implementation, 47% of eligible pediatric patients were screened, with some variation in compliance by age group and practice type. This study demonstrated that engaging nursing and frontline staff to screen pediatric patients for behavioral determinants of health is feasible. Ongoing outreach and refreshers may improve sustainability.
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Affiliation(s)
- Bethany L Howell
- Author Affiliations: Patient Education and Nursing Clinical Advancement, Clinical Education, Atrium Health Wake Forest Baptist Medical Center (Ms Howell); Department of Pediatrics, Department of Epidemiology and Prevention, Wake Forest School of Medicine (Dr Skelton), Winston-Salem; General Internal Medicine, Duke Primary Care, Duke University, Raleigh (Dr Jayaprakash); and Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem (Dr Lewis), NC
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Muacevic A, Adler JR. Artificially Sweetened Beverages Beyond the Metabolic Risks: A Systematic Review of the Literature. Cureus 2023; 15:e33231. [PMID: 36741610 PMCID: PMC9891650 DOI: 10.7759/cureus.33231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2023] [Indexed: 01/04/2023] Open
Abstract
We carried out a review of the available literature on the effects that artificially sweetened beverages (ASBs) such as diet soda (DS) have on health, particularly those not related to incident diabetes mellitus, obesity, and metabolic syndrome. A search of scientific articles was carried out using 11 different databases: PubMed, Cochrane, LILACS, MEDLINE Ovid, JAMA Network, IBECS, Cumed, Scopus, SciELO, MEDLINE-EBSCO, and Taylor & Francis Online. Articles published in the last 10 years were considered, considering cross-sectional studies, retrospective or prospective cohort studies, case-control studies, and randomized controlled clinical trials. Only articles in Spanish or English were considered using the MeSH (Medical Subject Heading) and DeCS (Descriptores en Ciencias de la Salud) terms, including "Diet soda," "Health," "Artificial sweetener," "Gaseosa sin azúcar," "Refresco sin azúcar," and "Salud." Additionally, Boolean operators "AND" and "Y" were used. A total of 1,323 articles were obtained in the initial search, of which 21 main ones were selected for review, which included the topic of DS consumption and explored the health consequences that it poses on different organs. The question of whether ASBs such as DS are a preferred substitute is becoming more and more important in terms of public policy due to mounting evidence of the potential negative health effects of their excessive consumption. This systematic review, the first of its kind to our knowledge, sheds light on how excessive DS consumption can affect multiple organ systems, and associations have been made to mental health burden, delays in child neurodevelopment, cardiac remodeling, worsening retinopathy in diabetics, incidental end-stage renal disease, non-Hodgkin's lymphoma and multiple myeloma in men, rheumatoid arthritis in women, hip fractures, dental erosion, increases in breath alcohol concentration when used in alcoholic beverages, and accelerated cell aging. Further studies should delve further to understand the pathophysiologic mechanisms of these associations.
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Diaz-Beltran M, Almanza B, Byrd K, Behnke C, Nelson D. Visual Cues and Optimal Defaults in Fast-Food Combo Meals Benefit Health-Concerned Consumers-A Randomized Scenario-Based Experiment. J Acad Nutr Diet 2023; 123:52-64.e1. [PMID: 35710044 DOI: 10.1016/j.jand.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of low-calorie menu items as optimal defaults and visual cues may nudge consumers to healthier choices at restaurants. However, little is known regarding their effects on emotions and behavioral intentions, particularly among people with different levels of health concern. OBJECTIVE Evaluate optimal defaults and visual cues' effect on anticipated pleasure and order intention depending upon consumers' health concern level. DESIGN Between-subjects randomized scenario-based experiment. PARTICIPANTS/SETTING In all, 636 US adults recruited through an online crowdsourcing platform in July 2020. INTERVENTION Participants saw 1 of 6 menu boards in a fast-food drive-through simulation. Half the menu boards included meal photos with (1) menu items to be arranged as a combo by choice (ie, create-your-own combo); (2) traditional combos that included high-calorie default items; or (3) optimal combos that included low-calorie default items. The remaining 3 boards were identical without photos. MAIN OUTCOME MEASURES Anticipated pleasure, order intention, and health concern were evaluated with 7-point Likert scales. ANALYSIS Statistical tests included multiple regression, Kruskal-Wallis, χ2, and analysis of variance. Education and sex were tested as potential confounders. RESULTS Optimal combos negatively affected anticipated pleasure (P = .003) and order intention (P < .001) compared with choice combos. Order intention reduction was the same for traditional and optimal combos (P = .128). The presence of photos changed order intention for optimal combos but varied by consumer's health concern level. When health concern was lower, photos decreased the likelihood of ordering the optimal combos (B = -3.06, P = .001), but when health concern was higher, photos enhanced ordering intention compared with the choice group (B = 0.60, P = .001). The photos did not affect anticipated pleasure for any level of health concern. CONCLUSIONS The adverse effect of optimal defaults and how visual cues may reduce their negative effect should be considered in menu design.
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Affiliation(s)
- Monica Diaz-Beltran
- Nutrition and Biochemistry Department, Pontificia Universidad Javeriana, Bogota, Colombia.
| | - Barbara Almanza
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Karen Byrd
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Carl Behnke
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Douglas Nelson
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
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Adolescents' knowledge and beliefs regarding health risks of soda and diet soda consumption. Public Health Nutr 2022; 25:3044-3053. [PMID: 35983831 PMCID: PMC9991753 DOI: 10.1017/s1368980022001719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine Australian adolescents' knowledge and beliefs regarding potential health consequences of soda and diet soda consumption and nutritional aspects of soda and explore associations with consumption. DESIGN A survey utilising a nationally representative sample (stratified two-stage probability design) assessed knowledge of nutritional contents and health consequences of soda, and beliefs regarding health risks of diet soda, and soda and diet drink consumption. SETTING Australia. PARTICIPANTS 9102 Australian school students (12-17 years) surveyed in 2018. RESULTS Adolescents had lower nutritional knowledge (sugar content (22·2 %), exercise equivalent (33·9 %), calories/kJ (3·1 %)) than general knowledge of health risks (87·4 %) and some health effects (71·7-75·6 % for tooth decay, weight gain and diabetes), with lower knowledge of heart disease (56·0 %) and cancer (19·3 %). Beliefs regarding health effects of diet soda were similar, albeit not as high. In general, female sex, older age and less disadvantage were associated with reporting health effects of soda and diet soda, and nutritional knowledge of soda (P < 0·001). Those reporting tooth decay, weight gain, heart disease and diabetes as health effects of soda and diet soda were lower consumers of soda and diet drinks (P < 0·001), as were those with higher nutritional knowledge (sugar content and exercise equivalent; P < 0·001). CONCLUSIONS This study highlights possible knowledge gaps regarding the health effects of soda and nutritional knowledge for public health intervention. When implementing such interventions, it is important to monitor the extent to which adolescents may consider diet drinks as an alternative beverage given varied beliefs about health consequences and evolving evidence.
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Sigala DM, Hall MG, Musicus AA, Roberto CA, Solar SE, Fan S, Sorscher S, Nara D, Falbe J. Perceived effectiveness of added-sugar warning label designs for U.S. restaurant menus: An online randomized controlled trial. Prev Med 2022; 160:107090. [PMID: 35594928 PMCID: PMC9236625 DOI: 10.1016/j.ypmed.2022.107090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 12/01/2022]
Abstract
Added-sugar consumption in the U.S. exceeds recommended limits. Policymakers are considering requiring restaurants to use menu warning labels to indicate items high in added sugar. We sought to determine whether icon-only and icon-plus-text added-sugar menu labels were (1) perceived as more effective at potentially reducing consumption of items high in added sugar and (2) increased knowledge of menu items' added-sugar content relative to control labels, and if effects differed by label design. A national sample of U.S. adults (n = 1327) participated in an online randomized experiment. Participants viewed menu items with either a control label, 1 of 6 icon-only labels, or 1 of 18 icon-plus-text labels with 3 text variations. For their assigned label, participants provided ratings of perceived message effectiveness (a validated scale of a message's potential to change behavior). Participants were also asked to classify menu items by their added-sugar content. The icon-only and icon-plus-text labels were perceived as more effective than the control label (means: 3.7 and 3.7 vs. 3.1, respectively, on a 5-point scale; p < 0.001). The icon-only and icon-plus-text groups each correctly classified 71% of menu items by added-sugar content vs. 56% in the control group (p < 0.001). All icons and text variations were perceived as similarly effective. In conclusion, relative to a control label, icon-only and icon-plus-text added-sugar menu labels were perceived as effective and helped consumers identify items high in added sugar. Menu warning labels may be a promising strategy for reducing added-sugar consumption from restaurants, but research on behavioral effects in real-world settings is needed. Clinical Trials Identifier:NCT04637412.
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Affiliation(s)
- Desiree M Sigala
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, 1 Shields Ave, Davis, CA 95616, USA.
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health; Lineberger Comprehensive Cancer Center; and Carolina Population Center; University of North Carolina Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
| | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Building 421, Philadelphia, PA 19104, USA.
| | - Sarah E Solar
- Human Development and Family Studies Program, Department of Human Ecology, University of California Davis, 1 Shields Ave, Davis, CA 95616, USA.
| | - Sili Fan
- Department of Statistics, University of California Davis, 1 Shields Ave, Davis, CA 95616, USA.
| | - Sarah Sorscher
- The Center for Science in the Public Interest, 1220 L St. N.W., Suite 300, Washington, D.C. 20005, USA.
| | - DeAnna Nara
- The Center for Science in the Public Interest, 1220 L St. N.W., Suite 300, Washington, D.C. 20005, USA.
| | - Jennifer Falbe
- Human Development and Family Studies Program, Department of Human Ecology, University of California Davis, 1 Shields Ave, Davis, CA 95616, USA.
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Miller C, Wright K, Dono J, Pettigrew S, Wakefield M, Coveney J, Wittert G, Roder D, Durkin S, Martin J, Ettridge K. "You can't just eat 16 teaspoons of sugar so why would you drink 16 teaspoons' worth of sugar?": a qualitative study of young adults' reactions to sugary drink warning labels. BMC Public Health 2022; 22:1241. [PMID: 35733102 PMCID: PMC9219237 DOI: 10.1186/s12889-022-13648-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Several jurisdictions have introduced nutrient warning front of pack (FoP) labels in an effort to curb consumption of ultra-processed foods and beverages high in free sugars (sugars added to foods and beverages, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates). This study aimed to explore consumer understanding and perceptions of FoP warning labels that convey different nutritional and health information messages regarding the consumption of sugary drinks. Methods Sixteen focus groups were held with 4–8 young adults per group (aged 18–24; n = 105 participants in total) stratified by education level, location (rural centres, large cities) and gender (males, females) to ensure diversity. Labels shown to participants during group discussions included text warning labels of health effects, exercise equivalents, calorie/kilojoule information and sugar content as a “high in” label and as teaspoons (text and pictograms). Thematic analysis was undertaken. Results Four themes were identified related to participants’ perceived effectiveness of labels: the extent to which labels were perceived to be useful, relevant and credible; the extent to which a label elicited shock or disgust (perceived aversiveness); the extent to which the label message was resistant to self-exemption; and participants’ perceived potential of the label to reduce purchasing and consumption behaviour. Across all four themes, labels communicating the number of teaspoons of sugar in a sugary drink (whether by text or pictogram) were perceived as the most impactful, resistant to self-exemption and to have the greatest potential to reduce consumption, with enhanced reactions to the pictogram label. Labels depicting health effects, exercise equivalents, calorie/kilojoule information or a general ‘high in sugar’ warning were perceived by consumers to be less effective in one or more themes. Conclusions Labels conveying the amount of sugar in a beverage in teaspoons were perceived as highly factual, relatable and interpretable, and as having the greatest potential to impact consumption attitudes and intentions. Further quantitative studies are required to compare the potential effectiveness of the teaspoons of sugar labels in reducing purchasing and consumption behaviour than other alternative warning labels, such as health effects or “high in” sugar labels. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13648-1.
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Affiliation(s)
- C Miller
- The University of Adelaide's School of Public Health, Adelaide, Australia. .,Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - K Wright
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.,The University of Adelaide's School of Psychology, Adelaide, Australia
| | - J Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.,The University of Adelaide's School of Psychology, Adelaide, Australia
| | - S Pettigrew
- Food Policy, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - M Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - G Wittert
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.,Centre for Nutrition and GI Diseases, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - D Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, Australia
| | - S Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Martin
- Obesity Policy Coalition and Alcohol and Obesity Policy, Cancer Council Victoria, Melbourne, Australia
| | - K Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.,The University of Adelaide's School of Psychology, Adelaide, Australia
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Prada M, Saraiva M, Garrido MV, Sério A, Teixeira A, Lopes D, Silva DA, Rodrigues DL. Perceived Associations between Excessive Sugar Intake and Health Conditions. Nutrients 2022; 14:640. [PMID: 35276998 PMCID: PMC8839066 DOI: 10.3390/nu14030640] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 01/02/2023] Open
Abstract
Excessive sugar intake represents an increased risk of developing non-communicable diseases (e.g., obesity, cardiometabolic diseases, and dental diseases). Still, it is unclear whether people are aware of these adverse health outcomes. The current study systematically examined the extent to which people associate health conditions with excessive sugar intake. Participants (N = 1010 Portuguese volunteers) freely reported all health conditions they associated with excessive sugar consumption and rated the strength of these associations for eight specific health conditions. All participants reported health conditions associated with excessive sugar intake, with the most frequent being risk factors for cardiometabolic diseases (e.g., diabetes), cardiovascular diseases, oral problems, oncological and mental health conditions. Moreover, participants considered diabetes, overweight/obesity, and oral problems as being the conditions most related to excessive sugar intake. Women, participants with children in the household, and experts in health/nutrition rated excessive sugar intake as being more strongly linked to some of the health conditions. The identification of the health conditions that people associate with excessive sugar consumption may inform policymakers, educators, and health professionals and support interventions targeting the general public or specific groups (e.g., overweight people) in raising awareness of potential adverse health outcomes and, ultimately, contribute to reducing sugar intake.
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Affiliation(s)
- Marília Prada
- Department of Social and Organizational Psychology, Iscte-Instituto Universitário de Lisboa, CIS_Iscte, Av. das Forças Armadas, Office AA110, 1649-026 Lisboa, Portugal; (M.S.); (M.V.G.); (A.S.); (A.T.); (D.L.); (D.L.R.)
| | - Magda Saraiva
- Department of Social and Organizational Psychology, Iscte-Instituto Universitário de Lisboa, CIS_Iscte, Av. das Forças Armadas, Office AA110, 1649-026 Lisboa, Portugal; (M.S.); (M.V.G.); (A.S.); (A.T.); (D.L.); (D.L.R.)
| | - Margarida V. Garrido
- Department of Social and Organizational Psychology, Iscte-Instituto Universitário de Lisboa, CIS_Iscte, Av. das Forças Armadas, Office AA110, 1649-026 Lisboa, Portugal; (M.S.); (M.V.G.); (A.S.); (A.T.); (D.L.); (D.L.R.)
| | - Ana Sério
- Department of Social and Organizational Psychology, Iscte-Instituto Universitário de Lisboa, CIS_Iscte, Av. das Forças Armadas, Office AA110, 1649-026 Lisboa, Portugal; (M.S.); (M.V.G.); (A.S.); (A.T.); (D.L.); (D.L.R.)
| | - Ana Teixeira
- Department of Social and Organizational Psychology, Iscte-Instituto Universitário de Lisboa, CIS_Iscte, Av. das Forças Armadas, Office AA110, 1649-026 Lisboa, Portugal; (M.S.); (M.V.G.); (A.S.); (A.T.); (D.L.); (D.L.R.)
| | - Diniz Lopes
- Department of Social and Organizational Psychology, Iscte-Instituto Universitário de Lisboa, CIS_Iscte, Av. das Forças Armadas, Office AA110, 1649-026 Lisboa, Portugal; (M.S.); (M.V.G.); (A.S.); (A.T.); (D.L.); (D.L.R.)
| | - Diana A. Silva
- Departamento Médico do Clube de Futebol “Os Belenenses”, 1449-015 Lisboa, Portugal;
| | - David L. Rodrigues
- Department of Social and Organizational Psychology, Iscte-Instituto Universitário de Lisboa, CIS_Iscte, Av. das Forças Armadas, Office AA110, 1649-026 Lisboa, Portugal; (M.S.); (M.V.G.); (A.S.); (A.T.); (D.L.); (D.L.R.)
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11
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Dunford EK, Coyle DH, Louie JCY, Rooney K, Blaxland A, Pettigrew S, Jones A. Changes in the presence of non-nutritive sweeteners, sugar alcohols and free sugars in Australian foods. J Acad Nutr Diet 2021; 122:991-999.e7. [PMID: 34864247 DOI: 10.1016/j.jand.2021.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/25/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND In parallel with growing consumer interest in reducing sugar intake, manufacturers have increased availability of food and beverage products containing non-nutritive sweeteners (NNS). However, emerging evidence indicates that specific NNS types have differential effects on cardiometabolic health. OBJECTIVE This study examined overall changes in the presence of NNS, sugar alcohols and free sugars (FS) in the Australian food supply and the use of specific NNS types. PARTICIPANTS/SETTING Data for 21,051 products in 2015 and 21,366 products in 2019 were extracted from The George Institute's FoodSwitch database. MAIN OUTCOME MEASURES The proportion of products containing NNS, sugar alcohols, FS and a combination of these, as well as proportion of products containing specific NNS types. STATISTICAL ANALYSES PERFORMED Changes between 2015 and 2019 were examined using Pearson χ2 tests. RESULTS Between 2015 and 2019 there was a significant increase in the proportion of food and beverage products containing NNS (3.8% to 4.3%; p<0.001) and a significant decrease in products containing free sugars (62.7% to 59.9%; p<0.001),) driven primarily by Non-dairy beverages. There were changes in the use of specific NNS types between 2015 and 2019, with a large increase in the use of steviol glycosides (33.7% to 50.2%) and a large decrease in the use of sucralose (42.4% to 30.5%), aspartame (21.0% to 14.4%) and acesulfame K (57.4% to 27.7%) (p<0.05 for all). CONCLUSIONS These findings on the use of different NNS, sugar alcohol and free sugar ingredients and combinations provide important research insights and will be useful in informing government policies that address sugars and other sweeteners in Australian foods.
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Affiliation(s)
- Elizabeth K Dunford
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA; Food Policy Division, The George Institute for Global Health, University of New South Wales, Newtown, Australia.
| | - Daisy H Coyle
- Food Policy Division, The George Institute for Global Health, University of New South Wales, Newtown, Australia
| | - Jimmy Chun Yu Louie
- Food Policy Division, The George Institute for Global Health, University of New South Wales, Newtown, Australia; Discipline of Food and Nutritional Science, School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong
| | - Kieron Rooney
- Discipline of Exercise and Sport Science, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Anneliese Blaxland
- Discipline of Exercise and Sport Science, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Simone Pettigrew
- Food Policy Division, The George Institute for Global Health, University of New South Wales, Newtown, Australia
| | - Alexandra Jones
- Food Policy Division, The George Institute for Global Health, University of New South Wales, Newtown, Australia
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12
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Miller C, Ettridge K, Pettigrew S, Wittert G, Wakefield M, Coveney J, Roder D, Martin J, Brownbill A, Dono J. Warning labels and interpretive nutrition labels: Impact on substitution between sugar and artificially sweetened beverages, juice and water in a real-world selection task. Appetite 2021; 169:105818. [PMID: 34838869 DOI: 10.1016/j.appet.2021.105818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
Effective strategies to reduce free sugar intake are needed. This study examined exposure to a warning label, independently and in conjunction with a Health Star Rating (HSR) label, on the selection of commercially available cold beverages with real decision-making stakes. Participants (N = 511, 47.9% female, mean = 21.7 (SD = 6.1) years) accessed an online convenience store app via an on-campus laptop to select one of 10 beverages (5 sugar-sweetened beverages [SSBs], 1100% fruit juice, 2 artificially sweetened beverages [ASBs] and 2 waters). The task was repeated with the addition of a warning label on high-sugar drinks in Round 2, and the addition of an HSR label on all drinks in Round 3. Participants were informed that they would receive a complementary drink (valued at <$5AUD) based on their selections following the completion of a brief questionnaire. Baseline results indicated that SSBs and waters were the most and least popular choices, respectively. For both males and females, there was a significant decrease in SSB selection (p < 0.001) and significant increase in ASB and water selection (p < 0.001) following the addition of warning labels to high-sugar drinks. The decreased selection of SSBs and increased selection of waters was maintained in Round 3 when HSR labels were added to all drinks. 100% fruit juice selection decreased with the addition of a warning label for females only (p < 0.01), but increased following the addition of a 4-star HSR label, for both males (p < 0.05) and females (p < 0.001). Warning labels reduced young adults' selection of SSBs and promoted substitution to water. The HSR reinforced this effect for the least healthy drinks. Increased water selection may be further enhanced by ensuring that warning label thresholds and HSR algorithms align to present consistent messaging.
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Affiliation(s)
- Caroline Miller
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Public Health, The University of Adelaide, Adelaide, Australia.
| | - Kerry Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Simone Pettigrew
- Food Policy, The George Institute for Global Health, Sydney, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia; Centre for Nutrition and GI Diseases, South Australian Health and Medical Research Institute Adelaide, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - John Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Australia
| | - Jane Martin
- Obesity Policy Coalition and Alcohol and Obesity Policy, Cancer Council Victoria, Melbourne, Australia
| | - Aimee Brownbill
- Foundation for Alcohol Research and Education, Canberra, Australia
| | - Joanne Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
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