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Lemmon B, Montuclard A, Solar SE, Roberts E, Joo TW, Falbe J. Student Opposition to University Pouring Rights Contracts. AJPM Focus 2024; 3:100190. [PMID: 38357553 PMCID: PMC10864850 DOI: 10.1016/j.focus.2024.100190] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Introduction The majority of large public universities have exclusive pouring rights contracts with beverage companies that produce and market sugar-sweetened beverages. Pouring rights contracts contain provisions that conflict with recommendations from major public health organizations that institutions reduce sugar-sweetened beverage availability, marketing, and consumption. This study assessed the following among students at 3 public universities: student perception of pouring rights contracts (the extent to which they favored or opposed pouring rights contracts), the association between student socioeconomic characteristics and perception of pouring rights contracts, student estimates of pouring rights contract revenue, and the association between student pouring rights contract revenue estimates and perception of pouring rights contracts. To contextualize results, actual pouring rights contract revenue as a percentage of total revenues was estimated. Methods A cross-sectional exploratory study was conducted among a convenience sample of 1,311 undergraduate sugar-sweetened beverages-consuming students recruited from 3 large and diverse public universities in Northern California. On an online questionnaire, undergraduate students indicated the extent to which they favored or opposed pouring rights contracts on a 10-point scale (oppose=1-5, favor=6-10) and provided a numeric estimate of the percentage of total university revenue they thought their university's pouring rights contract generated. Regression models were used to analyze differences in perception of pouring rights contracts by student socioeconomic characteristics and estimates of university revenues generated by pouring rights contracts. In addition, pouring rights contracts and financial reports were obtained from the 3 universities to estimate actual pouring rights contract revenue as a percentage of total revenues. Survey data were collected between August and November 2018 and analyzed in August 2022. Results A large majority of students (81%) opposed pouring rights contracts, and the opposition did not significantly differ by student socioeconomic characteristics, including by levels of food security, need-based financial aid, participation in federal food assistance or healthcare programs, parental education, or parental income (all ps>0.14). The median student estimate for pouring rights contract revenue as a percentage of total university revenue was 10%. In contrast, the estimated actual annual revenue generated from the pouring rights contracts ranged from 0.01% to 0.04% at these schools. Revenue estimates were not significantly associated with participants' opposition or favoring of pouring rights contracts (p=0.65). Conclusions A large majority of students opposed pouring rights contracts, and this opposition was similar regardless of student socioeconomic characteristics or student estimates of pouring rights contract revenues. Students markedly overestimated (by >100-1,000-fold) the percentage of university revenue that came from pouring rights contracts. University administration should consider student views on pouring rights contracts when deciding whether to exit or continue with pouring rights contracts.
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Affiliation(s)
- Brittany Lemmon
- Graduate Group in Epidemiology, University of California, Davis, Davis, California
| | - Astrid Montuclard
- Department of Human Ecology, University of California, Davis, Davis, California
| | - Sarah E. Solar
- Department of Human Ecology, University of California, Davis, Davis, California
| | - Emily Roberts
- Graduate Group in Nutritional Biology, Department of Nutrition, University of California, Davis, Davis, California
| | - Thomas W. Joo
- School of Law, University of California, Davis, Davis, California
| | - Jennifer Falbe
- Department of Human Ecology, University of California, Davis, Davis, California
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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] [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: 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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Falbe J, Marinello S, Wolf EC, Solar SE, Schermbeck RM, Pipito AA, Powell LM. Food and Beverage Environments at Store Checkouts in California: Mostly Unhealthy Products. Curr Dev Nutr 2023; 7:100075. [PMID: 37250387 PMCID: PMC10213198 DOI: 10.1016/j.cdnut.2023.100075] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Background As the only place in a store where customers must pass through, checkouts may be especially influential over purchases. Research is needed to understand the healthfulness of checkout environments. Objectives The objective of this study was to classify checkout product facings in California food stores. Methods In a cross-sectional study, 102 stores, including chains (dollar stores, drugstores, specialty food stores, supermarkets, and mass merchandisers) and independent supermarkets and grocery stores were sampled from 4 northern California cities. Observational assessments of each checkout product facing were conducted in February 2021 using the Store CheckOUt Tool. Facings were classified by category and healthfulness, defined by meeting Berkeley's Healthy Checkout Ordinance's healthy checkout standards: unsweetened beverages and specific foods containing ≤5 g added sugar and ≤200 mg sodium per serving. Log binomial regressions compared healthfulness by store and checkout characteristics. Results Of 26,758 food and beverage checkout facings, the most common categories were candy (31%), gum (18%), sugar-sweetened beverages (SSBs; 11%), salty snacks (9%), mints (7%), and sweets (6%). Water represented only 3% and fruits and vegetables 1% of these facings. Only 30% of food and beverage facings met Berkeley's healthy checkout standards, with 70% not meeting the standards. The percentage of food and beverage facings not meeting the standards was even higher (89%) among snack-sized packages (≤2 servings/package). Compared with chain supermarkets, mass merchandisers, and specialty food stores (34%-36%), dollar and independent grocery stores had a lower percentage of food and beverage facings that met the healthy checkout standards (18%-20%; P < 0.05). Compared with lane and register areas (35%), endcaps and snaking sections within checkouts had fewer food and beverage facings that met the standards (21%-23%; P < 0.001). Conclusions Most foods and beverages at checkout consisted of candy, SSBs, salty snacks, and sweets and failed to meet the healthy checkout standards.Curr Dev Nutr 2023;xx:xx.
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Affiliation(s)
- Jennifer Falbe
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA, United States
| | - Samantha Marinello
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Ethan C. Wolf
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA, United States
- Public Health Nutrition Program, Community Health Sciences, UC Berkeley School of Public Health, Berkeley, CA, United States
| | - Sarah E. Solar
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA, United States
| | - Rebecca M. Schermbeck
- Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Andrea A. Pipito
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Lisa M. Powell
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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