The impact of pictorial health warnings on purchases of sugary drinks for children: A randomized controlled trial

Pictorial warnings on tobacco products are promising for motivating behavior change, but few studies have examined pictorial warnings for sugary drinks, especially in naturalistic environments. This study aimed to examine the impact of pictorial warnings on parents' purchases of sugary drinks f...

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Bibliographic Details
Published in:PLoS medicine 2022-02, Vol.19 (2), p.e1003885-e1003885
Main Authors: Hall, Marissa G, Grummon, Anna H, Higgins, Isabella C A, Lazard, Allison J, Prestemon, Carmen E, Avendaño-Galdamez, Mirian I, Taillie, Lindsey Smith
Format: Article
Language:English
Subjects:
Adult
Behavior
Beverages
Biology and Life Sciences
Calories
Carbonated beverages
Child
Child, Preschool
Children
Consumer Behavior - statistics & numerical data
Diabetes mellitus (non-insulin dependent)
Female
Food Labeling - statistics & numerical data
Health aspects
Health promotion
Households
Humans
Labeling
Male
Medicine and Health Sciences
Methods
Middle Aged
North Carolina
Parents
Parents - psychology
People and Places
Purchasing
Research and Analysis Methods
Social interactions
Soft drinks
Sugar-Sweetened Beverages
Warning labels
Young Adult
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Summary:Pictorial warnings on tobacco products are promising for motivating behavior change, but few studies have examined pictorial warnings for sugary drinks, especially in naturalistic environments. This study aimed to examine the impact of pictorial warnings on parents' purchases of sugary drinks for their children in a naturalistic store laboratory. Parents of children ages 2 to 12 (n = 325, 25% identifying as Black, 20% Hispanic) completed a shopping task in a naturalistic store laboratory in North Carolina. Participants were randomly assigned to a pictorial warnings arm (sugary drinks displayed pictorial health warnings about type 2 diabetes and heart damage) or a control arm (sugary drinks displayed a barcode label). Parents selected 1 beverage and 1 snack for their child, as well as 1 household good; one of these items was selected for them to purchase and take home. The primary outcome was whether parents purchased a sugary drink for their child. Secondary outcomes included reactions to the trial labels, attitudes toward sugary drinks, and intentions to serve their child sugary drinks. Pictorial warnings led to a 17-percentage point reduction in purchases of sugary drinks (95% CI for reduction: 7% to 27%), with 45% of parents in the control arm buying a sugary drink for their child compared to 28% in the pictorial warning arm (p = 0.002). The impact of pictorial warnings on purchases did not differ by any of the 13 participant characteristics examined (e.g., race/ethnicity, income, education, and age of child). Pictorial warnings also led to lower calories (kcal), purchased from sugary drinks (82 kcal in the control arm versus 52 kcal in the pictorial warnings arm, p = 0.003). Moreover, pictorial warnings led to lower intentions to serve sugary drinks to their child, feeling more in control of healthy eating decisions, greater thinking about the harms of sugary drinks, stronger negative emotional reactions, greater anticipated social interactions, lower perceived healthfulness of sugary drinks for their child, and greater injunctive norms to limit sugary drinks for their child (all p < 0.05). There was no evidence of difference between trial arms on noticing of the labels, appeal of sugary drinks, perceived amount of added sugar in sugary drinks, risk perceptions, or perceived tastiness of sugary drinks (all p > 0.05). Pictorial warnings reduced parents' purchases of sugary drinks for their children in this naturalistic trial. Warnings on sugary drinks a
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1003885