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Lowery CM, Roberto CA, Hua SV, Bleich SN, Mitra N, Lawman HG, Taillie LS, Ng SW, Gibson LA. Impact of the Philadelphia Beverage Tax on Perceived Beverage Healthfulness, Tax Awareness, and Tax Opinions. J Nutr Educ Behav 2024:S1499-4046(24)00025-3. [PMID: 38466246 DOI: 10.1016/j.jneb.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/24/2024] [Accepted: 02/04/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To assess the impact of the Philadelphia Beverage Tax on perceived beverage healthfulness, and awareness and opinions of the tax. DESIGN Natural experiment SETTING: Small independent stores in Philadelphia (n = 61) and Baltimore (untaxed control site; n = 65) PARTICIPANTS: Shoppers in Philadelphia (n = 2,731) and Baltimore (n = 4,600) pre- and post-tax implementation. MAIN OUTCOME MEASURES Perceptions of 4 beverages (unhealthy vs healthy/neutral), tax awareness, and tax opinions (oppose vs favor/neutral). ANALYSIS Mixed-effects linear probability models estimated changes in perceived beverage healthfulness in Philadelphia, relative to Baltimore, following a difference-in-differences approach. Mixed-effects linear probability models estimated pre-post changes in tax awareness and opinions in Philadelphia-only. RESULTS The probability of perceiving taxed beverages as unhealthy increased 2-years post-tax relative to Baltimore (regular soda: 5.7% [95% confidence interval (CI), 0.9-10.6], P = 0.02; diet soda: 7.7% [95% CI, 1.5-13.8], P < 0.001; sports drinks: 6.4% [95% CI, 0.4-12.4], P = 0.04), with similar changes at 1-year post-tax, whereas perceived healthfulness of untaxed 100% fruit juice did not change. Tax awareness was high at baseline (72%) and increased post-implementation; however, the probability of opposing the tax (22%) also increased over time. CONCLUSIONS AND IMPLICATIONS Decreases in the perceived healthfulness of taxed beverages suggest the tax had a health-signaling effect. Consumer awareness and health education efforts could complement tax policies to enhance understanding of health risks.
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Affiliation(s)
- Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sophia V Hua
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Nandita Mitra
- Division of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hannah G Lawman
- Division of Chronic Disease Prevention and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, PA
| | - Lindsey S Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura A Gibson
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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D’Angelo-Campos A, Taillie LS, Vatavuk-Serrati G, Grummon AH, Higgins ICA, Hall MG. Effects of pictorial warnings on parents' purchases and perceptions of sugar-sweetened beverage categories. Pediatr Obes 2023; 18:e13030. [PMID: 36965067 PMCID: PMC10687846 DOI: 10.1111/ijpo.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/30/2023] [Accepted: 03/06/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Sugar-sweetened beverage (SSB) consumption remains high among US children. Warning labels on SSBs hold promise for reducing consumption, but their impact may differ by SSB category. OBJECTIVES This study examined the effects of pictorial warnings on parents' beverage purchases and perceptions across SSB categories. METHODS Parents of children ages 2-12 (n = 326) visited a convenience store laboratory in North Carolina. Participants were randomly assigned to see SSBs carrying either pictorial warning labels or control labels. Parents purchased a beverage for their child and completed a survey. RESULTS Responses from parents in the control arm suggest underlying perceptions of flavoured milk (2.8 on scale ranging from 1 to 5), flavoured water (2.6), and fruit-flavoured drinks (2.5) as the most healthful SSB categories. Compared to the control, pictorial warnings led to the largest reductions in purchases of fruit drinks (-61%), soda (-36%) and flavoured milk (-32%). Warnings also lowered the perceived healthfulness of flavoured water (d = -0.34), flavoured milk (d = -0.28), sports drinks (d = -0.25), and a reduction in intentions to give one's child sports drinks (d = -0.30), flavoured water (d = -0.24) and sweet tea (d = -0.22, all p < 0.05). CONCLUSIONS Warning labels may have heterogeneous effects across SSB categories. Future research should assess the psychological mechanisms underlying these heterogeneous effects.
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Affiliation(s)
- Aline D’Angelo-Campos
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lindsey S Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gabriela Vatavuk-Serrati
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna H Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Isabella C. A Higgins
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Soldavini J, Taillie LS, Lytle LA, Berner M, Ward DS, Ammerman A. College student motivations for and perceived impacts of volunteering with a nutrition and cooking education program for children. J Community Psychol 2022; 50:2104-2115. [PMID: 34825379 DOI: 10.1002/jcop.22757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/28/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
To assess among college students their motivations for and perceived impacts of volunteering with Cooking Matters for Kids as part of No Kid Hungry NC. Seventeen college student volunteers responded to an online survey questionnaire assessing their motivations for volunteering and how they were impacted by their experiences. Motivational functions for volunteering (values, understanding, social, career, protective, enhancement) were assessed using the Volunteer Functions Inventory. The strongest motivational functions for volunteering were values and understanding. Students were also strongly motivated to volunteer related to the areas specifically addressed by the program (i.e., nutrition, public health, working with children). Perceived impacts of volunteering included being more comfortable working with children, improving knowledge/skills, gaining experience related to their future career, and having fun. Volunteering with Cooking Matters for Kids benefited college students. Issues addressed by the program and the desire to gain experience motivated students to volunteer.
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Affiliation(s)
- Jessica Soldavini
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey S Taillie
- Carolina Population Center and Department of Nutrition, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Leslie A Lytle
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maureen Berner
- School of Government, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alice Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Reimold AE, Grummon AH, Taillie LS, Brewer NT, Rimm EB, Hall MG. Barriers and facilitators to achieving food security during the COVID-19 pandemic. Prev Med Rep 2021; 23:101500. [PMID: 34401218 PMCID: PMC8348548 DOI: 10.1016/j.pmedr.2021.101500] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 10/28/2022] Open
Abstract
The COVID-19 pandemic has considerably increased food insecurity. To identify where intervention and policy solutions are most needed, we explored barriers to obtaining food and predictors of experiencing food insecurity due to the COVID-19 pandemic. Between May and July 2020, we conducted cross-sectional online surveys with two convenience samples of U.S. adults (Study 1: n = 2,219, Study 2: n = 810). Roughly one-third of participants reported experiencing food insecurity due to the COVID-19 pandemic (Study 1: 32%, Study 2: 35%). Between one-third and half reported using the charitable food system (Study 1: 36%, Study 2: 46%). The majority of participants experienced barriers to getting food (Study 1: 84%, Study 2: 88%), of which the most commonly reported were not having enough money to buy food (Study 1: 48%; Study 2: 53%) and worrying about getting COVID-19 at the store (Study 1: 50%; Study 2: 43%). Higher education was associated with greater risk of food insecurity in both studies (all p < 0.05). Receipt of aid from SNAP buffered against the association between financial struggles and food insecurity in Study 1 (p = 0.03); there was also some evidence of this effect in Study 2 (p = 0.05). Our findings suggest that food insecurity might be reduced by mitigating financial struggles (e.g., by increasing access to SNAP) and by addressing barriers to obtaining food (e.g., by expanding accessibility of food delivery programs).
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Affiliation(s)
- Alexandria E Reimold
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Lindsey S Taillie
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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5
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Araya C, Corvalán C, Cediel G, Taillie LS, Reyes M. Ultra-Processed Food Consumption Among Chilean Preschoolers Is Associated With Diets Promoting Non-communicable Diseases. Front Nutr 2021; 8:601526. [PMID: 33842518 PMCID: PMC8032866 DOI: 10.3389/fnut.2021.601526] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: In adults, intake of ultra-processed foods (UPF) has been linked with poor diets and adverse health outcomes. In young children, evidence is scarcer but suggests a higher dietary share of UPF. Objective: To quantify the intake of UPF and its association with the nutrient composition of the diet in a sample of preschoolers in Santiago, Chile. Methods: Cross-sectional analysis of dietary data (24-h recall survey) from 960 preschoolers. Foods were categorized according to the extent and purpose of processing (NOVA classification) and participants were classified in quintiles of UPF intake. We explored the associations between UPF intake (% of the total energy) and intake of nutrients of concern for non-communicable disease development (carbohydrates, total sugars, fats, and sodium), and nutrients for promotion (proteins, polyunsaturated fats, iron, calcium, zinc, vitamins A, D, C, and B12, folate, and fiber) using multivariate regression after controlling for covariates. Results: UPF constituted 49% of the total energy intake. Preschoolers with higher intake consumed more energy, saturated and monounsaturated fats, carbohydrates, total sugars, and vitamin D, compared to preschoolers in the lowest quintile of UPF intake. In contrast, UPF intake was negatively associated with the consumption of proteins, polyunsaturated fats, fiber, zinc, vitamin A, and sodium (p < 0.05). Conclusion: In Chilean preschoolers, UPF was the primary source of energy intake. The dietary share of UPF was associated with the nutrient composition of the diet. Improving children's diet should consider not only promoting healthy food consumption but also limiting UPF consumption.
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Affiliation(s)
- C Araya
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile.,Escuela de Nutrición y Dietética, Facultad de Salud, Universidad Santo Tomás, Santiago, Chile
| | - C Corvalán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - G Cediel
- Department of Nutrition, University of São Paulo, São Paulo, Brazil.,School of Nutrition and Dietetics, University of Antioquia, Medellín, Colombia
| | - L S Taillie
- Department of Nutrition, Carolina Population Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - M Reyes
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
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Duffy EW, Taillie LS, Richter APC, Higgins ICA, Harris JL, Hall MG. Parental Perceptions and Exposure to Advertising of Toddler Milk: A Pilot Study with Latino Parents. Int J Environ Res Public Health 2021; 18:E528. [PMID: 33435227 PMCID: PMC7827454 DOI: 10.3390/ijerph18020528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/27/2020] [Accepted: 01/05/2021] [Indexed: 12/31/2022]
Abstract
Marketing of toddler milk (i.e., typically sugar-sweetened nutrient-fortified milk-based drinks marketed for children 12-36 months) is an emerging public health problem in the US. The American Academy of Pediatrics recommends against the consumption of toddler milk because it often contains added sugar and can displace nutrient-dense foods. Studies have not examined toddler milk perceptions among Latinos, an important gap given Latino children in the US are at high risk of having poor diet quality, and toddler milk is extensively advertised on Spanish-language TV. This study used an online survey of a convenience sample of 58 Latino parents to examine parents' experiences with toddler milk, understand their perceptions of the healthfulness and the nutrition-related claims on toddler milk, and describe their exposure to toddler milk advertising. Nearly half (44%) of parents in the sample reported purchasing toddler milk. When asked to provide open-ended interpretations of claims on toddler milk, almost all parents gave positive answers, suggesting potential "health halo" effects of the claims. More than half (56%) of parents reported seeing toddler milk advertisements, most commonly on Spanish-language TV. The misperceptions about toddler milk identified should be explored in further research using larger, more representative samples.
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Affiliation(s)
- Emily W. Duffy
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (E.W.D.); (L.S.T.)
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.P.C.R.); (I.C.A.H.)
| | - Lindsey S. Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (E.W.D.); (L.S.T.)
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.P.C.R.); (I.C.A.H.)
| | - Ana Paula C. Richter
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.P.C.R.); (I.C.A.H.)
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC 27599, USA
| | - Isabella C. A. Higgins
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.P.C.R.); (I.C.A.H.)
| | - Jennifer L. Harris
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT 06103, USA;
| | - Marissa G. Hall
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.P.C.R.); (I.C.A.H.)
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC 27599, USA
- School of Medicine, UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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Velasquez A, Mora-Plazas M, Gómez LF, Taillie LS, Dillman Carpentier FR. Extent and nutritional quality of foods and beverages to which children are exposed in Colombian TV food advertising. Public Health Nutr 2020; 24:1-11. [PMID: 33234185 DOI: 10.1017/s1368980020004784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine children's exposure to food and beverage advertising across a year of Colombian television based on whether products exceed Pan-American Health Organization (PAHO)-defined nutrient thresholds. DESIGN Nutritional information was obtained for all foods and beverages advertised and used to categorise each product according to the product category (e.g. beverage, snack food) and nutritional quality based on the PAHO model for identifying products in excess of free sugars, Na or saturated fat or containing non-caloric sweeteners or trans-fat. Television audience ratings data were used to derive the average child audience (unique child viewers) per ad and the number of times ads were seen by children in a single week (weekly impressions) based on product category and nutritional quality. SETTING All food and beverage ads on cable and over-the-air TV in Colombia in 2017. PARTICIPANTS N/A. RESULTS Of all instances of TV ads, 89·3 % were of unhealthy products. A larger proportion of male and female children, as well as children from low (88·01 %), mid (89·10 %) and high (89·10 %) socio-economic status, are exposed to advertising of unhealthy products, but no significant difference was found between these proportions. CONCLUSION The majority of foods and beverages advertised to Colombian children are unhealthy. These findings highlight a need to implement statutory measures to reduce children's exposure to unhealthy food advertising in Colombia, as obesity and overweight have been increasing among school-age children in Colombia, and exposure to television advertising of unhealthy foods is a known contributor to children's food intake and obesity.
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Affiliation(s)
| | - Mercedes Mora-Plazas
- Departamento de Nutrición Humana, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - Lindsey S Taillie
- Carolina Population Center and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
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Grilo MF, Ricardo CZ, Taillie LS, Martins APB, Mais LA, Duran ACFL. Low-calorie-sweeteners in foods with front-of-package child-directed advertising in Brazil. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Low-calorie sweeteners (LCS) are currently found in ultra-processed foods, even in those with high content of sugar, without any front-of-package (FOP) information for LCS content. The aim was to assess the presence of LCS and the combination of LCS and added sugars in foods and beverages with FOP child-directed advertising in the Brazilian packaged food supply.
Methods
In this cross-sectional study, we used data from the nutrition facts panel (NFP) dataset that includes 11,434 unique foods and beverages collected in 2017 in the five largest food retailers in Brazil. We used information on the NFP and the list of ingredients to determine the presence of LCS and added sugars. A subsample of the packages had the available FOP advertising strategies classified using the INFORMAS methodology (n = 3,491). We estimated the prevalence of LCS and the combination of LCS and added sugar presence in the Brazilian food supply, and assessed the prevalence of foods and beverages with FOP child-directed advertising.
Results
Out of 3,491 products assessed, 8.9% of the products contained LCS, of which 12.9% were advertised towards children. Regarding the presence of LCS and added sugars, 7.3% of products presented that combination, with 14.6% of those having child-directed FOP advertising. The food groups with the highest prevalence of LCS were: sugary drinks (juices, nectars, fruit-flavored drinks, sodas and other beverages) (40.6%), breakfast cereals and granola bars (31.6%), and sweetened dairy products (23.5%). From those, 5.5%, 6.7% and 17.1%, accordingly, were advertised towards children.
Conclusions
In this sample, 9% of the foods contained LCS or a combination of LCS and added sugars. In products advertised towards children, we found higher rates of products with LCS and greater presence of LCS in beverages, breakfast cereals and granola bars with children-directed advertising.
Key messages
This study demonstrates that almost 9% of Brazilian packaged foods have LCS, and that 7% have both LCS and added sugars. In products advertised towards children, such rates were higher (13 - 15%). A clearer information on the front-of-package of foods and beverages regarding the presence of LCS in Brazil is necessary, particularly among those products advertised towards children.
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Affiliation(s)
- M F Grilo
- Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - C Z Ricardo
- School of Public Health, University of Chile, Santiago, Chile
| | - L S Taillie
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapell Hill, USA
| | - A P B Martins
- Brazilian Institute of Consumer Defense, São Paulo, Brazil
| | - L A Mais
- Brazilian Institute of Consumer Defense, São Paulo, Brazil
| | - A C F L Duran
- Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Center for Food Studies, University of Campinas, Campinas, Brazil
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
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Grummon AH, Taillie LS, Golden SD, Hall MG, Ranney LM, Brewer NT. Sugar-Sweetened Beverage Health Warnings and Purchases: A Randomized Controlled Trial. Am J Prev Med 2019; 57:601-610. [PMID: 31586510 PMCID: PMC6803129 DOI: 10.1016/j.amepre.2019.06.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Five U.S. states have proposed policies to require health warnings on sugar-sweetened beverages, but warnings' effects on actual purchase behavior remain uncertain. This study evaluated the impact of sugar-sweetened beverage health warnings on sugar-sweetened beverage purchases. STUDY DESIGN Participants completed one study visit to a life-sized replica of a convenience store in North Carolina. Participants chose six items (two beverages, two foods, and two household products). One item was randomly selected for them to purchase and take home. Participants also completed a questionnaire. Researchers collected data in 2018 and conducted analyses in 2019. SETTING/PARTICIPANTS Participants were a demographically diverse convenience sample of 400 adult sugar-sweetened beverage consumers (usual consumption ≥12 ounces/week). INTERVENTION Research staff randomly assigned participants to a health warning arm (sugar-sweetened beverages in the store displayed a front-of-package health warning) or a control arm (sugar-sweetened beverages displayed a control label). MAIN OUTCOME MEASURES The primary trial outcome was sugar-sweetened beverage calories purchased. Secondary outcomes included reactions to trial labels (e.g., negative emotions) and sugar-sweetened beverage perceptions and attitudes (e.g., healthfulness). RESULTS All 400 participants completed the trial and were included in analyses. Health warning arm participants were less likely to be Hispanic and to have overweight/obesity than control arm participants. In intent-to-treat analyses adjusting for Hispanic ethnicity and overweight/obesity, health warnings led to lower sugar-sweetened beverage purchases (adjusted difference, -31.4 calories; 95% CI= -57.9, -5.0). Unadjusted analyses yielded similar results (difference, -32.9 calories; 95% CI= -58.9, -7.0). Compared with the control label, sugar-sweetened beverage health warnings also led to higher intentions to limit sugar-sweetened beverage consumption and elicited more attention, negative emotions, thinking about the harms of sugar-sweetened beverage consumption, and anticipated social interactions. Trial arms did not differ on perceptions of sugar-sweetened beverages' added sugar content, healthfulness, appeal/coolness, or disease risk. CONCLUSIONS Brief exposure to health warnings reduced sugar-sweetened beverage purchases in this naturalistic RCT. Sugar-sweetened beverage health warning policies could discourage sugar-sweetened beverage consumption. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT03511937.
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Affiliation(s)
- Anna H Grummon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina.
| | - Lindsey S Taillie
- Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Leah M Ranney
- Department of Family Medicine, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
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Chauvenet C, Taillie LS. A Call to Oppose the Child Nutrition and Education Act of 2016 (H.R. 5003). Am J Public Health 2016; 106:2129-2130. [PMID: 27831786 PMCID: PMC5105016 DOI: 10.2105/ajph.2016.303479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Christina Chauvenet
- Christina Chauvenet is with the Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Lindsey Smith Taillie is with the Department of Nutrition, Gillings School of Global Public Health, and the Carolina Population Center, University of North Carolina, Chapel Hill
| | - Lindsey S Taillie
- Christina Chauvenet is with the Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Lindsey Smith Taillie is with the Department of Nutrition, Gillings School of Global Public Health, and the Carolina Population Center, University of North Carolina, Chapel Hill
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