Impacts of Sugar and Sweetener Warning Labels on Substitution Between Sugar- and Non-sugar-sweetened Beverages in a Non-hypothetical Selection Task

Overview

Journal BMC Med

Publisher Biomed Central

Specialty General Medicine

Date 2024 Nov 19

PMID 39558314

Authors

Caroline Miller

Enola Kay

Joanne Dono

Kerry Ettridge

Affiliations

Soon will be listed here.

Abstract

Background: Front-of-pack (FOP) warning labels have demonstrated effectiveness for reducing sugar-sweetened beverage (SSB) consumption and switching to water. However, an unintended consequence is that they may also increase switching to non-sugar-sweetened beverages (NSSBs). A non-hypothetical experimental study examined the effectiveness of combining sugar and sweetener FOP warning labels to reduce sugary drink consumption and prevent NSSB substitution. The study also examined potential integration with Australia and New Zealand's existing Health Star Rating (HSR) system to determine suitability for local context and other jurisdictions with interpretive labelling schemes already in place.

Methods: Participants (N = 414) accessed an online convenience store app via an on-campus laptop to select one drink from an array of 10 beverages, on three occasions. Drink options included a variety of SSBs, 100% fruit juice, NSSBs, and water. Following an escalating exposure procedure, drinks were presented (1) without any additional labelling, (2) with warning labels added to sugary drinks or to both sugary drinks and NSSBs (according to allocated condition), then (3) with HSR icons added to all drinks. Participants were informed they would receive a complementary drink, based on their selections, following the completion of a brief questionnaire.

Results: Baseline results indicated that SSBs and water were the most and least popular drink choices, respectively. Placing FOP warning labels on sugary drinks decreased selection of SSBs and increased NSSB and water choices. Water became the most popular individual drink choice in response to warnings on sugary drinks. Placing FOP warning labels on both sugary drinks and NSSBs successfully avoided an increase in NSSB choices, whilst also increasing water selections, but did not significantly decrease selection of SSBs until HSR ratings were added. The incorporation of HSR icons consolidated warning label effects on NSSB and water selection across both conditions.

Conclusions: Results demonstrate the potential of FOP sugar warning labels for addressing beverage consumption behaviours. The incorporation of sweetener warning labels may successfully avoid substitution towards NSSBs, whilst still promoting water choices, but may also dilute the impact of the sugary drinks warning labels. Warning labels were complementary to existing interpretive FOP labels.

References

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

Jones A, Neal B, Reeve B, Ni Mhurchu C, Thow A . Front-of-pack nutrition labelling to promote healthier diets: current practice and opportunities to strengthen regulation worldwide. BMJ Glob Health. 2020; 4(6):e001882. PMC: 6936575. DOI: 10.1136/bmjgh-2019-001882. View

Zhong Y, Auchincloss A, Lee B, Kanter G . The Short-Term Impacts of the Philadelphia Beverage Tax on Beverage Consumption. Am J Prev Med. 2018; 55(1):26-34. DOI: 10.1016/j.amepre.2018.02.017. View

Vall Castello J, Lopez Casasnovas G . Impact of SSB taxes on sales. Econ Hum Biol. 2019; 36:100821. DOI: 10.1016/j.ehb.2019.100821. View

Miller C, Dono J, Wright K, Pettigrew S, Wakefield M, Coveney J . "No Child or Adult Would Ever Probably Choose to Have 16 Teaspoons of Sugar": A Preliminary Study of Parents' Responses to Sugary Drink Warning Label Options. Nutrients. 2022; 14(19). PMC: 9571345. DOI: 10.3390/nu14194173. View

Harris P, Taylor R, Minor B, Elliott V, Fernandez M, ONeal L . The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019; 95:103208. PMC: 7254481. DOI: 10.1016/j.jbi.2019.103208. View

Smith Taillie L, Reyes M, Colchero M, Popkin B, Corvalan C . An evaluation of Chile's Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study. PLoS Med. 2020; 17(2):e1003015. PMC: 7012389. DOI: 10.1371/journal.pmed.1003015. View

Miller C, Ettridge K, Pettigrew S, Wittert G, Wakefield M, Coveney 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. DOI: 10.1016/j.appet.2021.105818. View

Miller C, Wright K, Dono J, Pettigrew S, Wakefield M, Coveney J . "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(1):1241. PMC: 9219237. DOI: 10.1186/s12889-022-13648-1. View

10.

Haque M, McKimm J, Sartelli M, Samad N, Haque S, Abu Bakar M . A narrative review of the effects of sugar-sweetened beverages on human health: A key global health issue. J Popul Ther Clin Pharmacol. 2020; 27(1):e76-e103. DOI: 10.15586/jptcp.v27i1.666. View

11.

Maganja D, Davies T, Sanavio L, Louie J, Huffman M, Trieu K . Current food labelling practices in online supermarkets in Australia. Int J Behav Nutr Phys Act. 2023; 20(1):105. PMC: 10521447. DOI: 10.1186/s12966-023-01504-3. View

12.

An R, Liu J, Liu R, Barker A, Figueroa R, McBride T . Impact of Sugar-Sweetened Beverage Warning Labels on Consumer Behaviors: A Systematic Review and Meta-Analysis. Am J Prev Med. 2020; 60(1):115-126. DOI: 10.1016/j.amepre.2020.07.003. View

13.

Arellano-Gomez L, Jauregui A, Nieto C, Contreras-Manzano A, Quevedo K, White C . Effects of front-of-package caffeine and sweetener disclaimers in Mexico: cross-sectional results from the 2020 International Food Policy Study. Public Health Nutr. 2023; 26(12):3278-3290. PMC: 10755452. DOI: 10.1017/S1368980023002100. View

14.

Malik V, Popkin B, Bray G, Despres J, Hu F . Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010; 121(11):1356-64. PMC: 2862465. DOI: 10.1161/CIRCULATIONAHA.109.876185. View

15.

Batista M, de Carvalho-Ferreira J, da Cunha D, de Rosso V . Front-of-package nutrition labeling as a driver for healthier food choices: Lessons learned and future perspectives. Compr Rev Food Sci Food Saf. 2022; 22(1):535-586. DOI: 10.1111/1541-4337.13085. View

16.

Dono J, Ettridge K, Wakefield M, Pettigrew S, Coveney J, Roder D . Nothing beats taste or convenience: a national survey of where and why people buy sugary drinks in Australia. Aust N Z J Public Health. 2020; 44(4):291-294. DOI: 10.1111/1753-6405.13000. View

17.

Keaney M, Maganja D, Barrett E, Pettigrew S, Jones A . Selective industry adoption of a voluntary front-of-pack nutrition label results in low and skewed uptake: 10-year results for the Health Star Rating. Eur J Clin Nutr. 2024; 78(10):916-918. PMC: 11458474. DOI: 10.1038/s41430-024-01480-2. View

18.

Lara-Castor L, Micha R, Cudhea F, Miller V, Shi P, Zhang J . Sugar-sweetened beverage intakes among adults between 1990 and 2018 in 185 countries. Nat Commun. 2023; 14(1):5957. PMC: 10614169. DOI: 10.1038/s41467-023-41269-8. View

19.

Miller C, Ettridge K, Pettigrew S, Wittert G, Coveney J, Wakefield M . 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. DOI: 10.1016/j.puhe.2024.01.026. View

20.

Malik V, Hu F . The role of sugar-sweetened beverages in the global epidemics of obesity and chronic diseases. Nat Rev Endocrinol. 2022; 18(4):205-218. PMC: 8778490. DOI: 10.1038/s41574-021-00627-6. View