1. Warning labels on sugar-sweetened beverages (SSBs) increased primary caregiver awareness regarding the adverse health effects and sugar content in these beverages.
2. There was no significant difference in parent decisions among variations in the text of warning labels and all warning labels significantly decreased the number of parents that would choose SSBs for their children compared to controls.
Evidence Rating Level: 2 (Good)
Study Rundown: A majority of young children will drink at least one SSB each day, with consequences that include risk of obesity and dental caries. Consequently, several states have introduced a policy to require warning labels on SSBs. This study sought to determine if such labels influence parental decision-making. Primary caregivers were shown 1 of 6 label conditions: no label (control), a calorie label, a warning label worded per California’s bill (Safety Warning: Drinking beverages with added sugar[s] contributes to obesity, diabetes, and tooth decay), a label that replaced “obesity” with “weight gain”, a label that inserted the phrase “preventable diseases like” before listing diseases, and a label that clarified diabetes as “Type 2 diabetes”. While there was no significant difference among the various warning labels, parents were less likely to choose a SSB for their child in the warning label groups compared to the control and calorie label groups. Parents in the warning labels group were more likely to believe that SSBs were unhealthy and that SSBs would increase their child’s risk of diabetes, obesity, and tooth decay. This study is limited by a potential overestimation of the effect of warning labels due to labels being enlarged when presented in the computer-formatted survey. Nonetheless, these findings can inform physicians to be aware of how warning labels may change parental behavior and to advocate for the standardized labeling of SSBs.
In-Depth [survey]: A total of 2381 primary caregivers of children aged 6 to 11 in the United States were recruited to participate in this survey through Survey Sampling International. Participants were 70.4% female, had an average of 2.3 children, and 30% had completed college. A majority of participants were white (67.5%), 28.2% were black, and 31% identified as Hispanic. Among caregivers in the warning label groups, 40.4% (SE 1.2) chose an SSB, compared to 59.9% (SE 2.4) and 53.3% (SE 2.5) of caregivers in the control and calorie groups, respectively (p< 0.001). Caregivers in the warning label groups chose significantly fewer SSB coupons (2.4 ± 0.06) compared to those in the control group (3.3 ± 0.13) and calorie label group (3.0 ± 0.12). Caregivers rated the amount of sugar higher on a scale of 1 to 4 in the warning label groups (3.1 ± 0.01) compared to the control group (2.8 ± 0.03) and calorie label group (2.9 ± 0.03). The calorie label group estimated the number of calories in SSBs more accurately than the warning label group (p < 0.001).
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