Online Study of the Effects of Sugary Drink Warning Labels on Consumption

Study Overview
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Brief Summary
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The aim of this study is to determine the degree to which sugar-sweetened beverages (SSB) warning labels increase consumers' knowledge about the potential health harms of SSBs and reduce SSB purchases and consumption. 216 racially and ethnically diverse parents of children 6-11 years old will be recruited to buy snacks and beverages for four weeks via an online store that ships participants their purchases. Participants will be randomized to either 1) calorie labels (control); or 2) sugar graphic warning labels. The investigators hypothesize that sugar graphic warning labels displayed in an online store in weeks 2-4 will lead to the greatest reductions from week 1 across both primary outcomes compared to the control group that will only see calorie labels.

Detailed Description
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During this study, participants will shop in an online store created using Shopify for four weeks. In this within-participant design, the first week of shopping is baseline. Participants will then be randomized to different store interfaces for the remaining three weeks based on one of two warning label conditions: 1) calorie labels (control); or 2) sugar graphic warning labels. Participants will complete a brief survey at the start of the study to assess demographic information, information about parent and child beverage consumption, and their online shopping experiences. At the end they will complete another survey about their beverage consumption, their experience shopping in the store, whether they noticed and used the warning labels, and their ability to recall the warning label message. Participants will also be asked about their perceptions of a specific type of warning label in this final survey. Upon completion of the survey, participants will be shown a debriefing statement explaining the study purpose. After they read the information, they will be asked whether or not they consent to allow their data to be used in this study.

Official Title
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Communicating the Health Risks of Sugar-Sweetened Beverages: A Randomized-controlled Experiment of Different Nutrition Labels on Purchases and Consumption

Conditions
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Food Preferences

Intervention / Treatment
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* Behavioral: Exposure to sugar-sweetened beverage warning labels
* Behavioral: Exposure to calorie information


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: a primary caregiver of a child 6-to-11 years old; >=18 years old; can read and speak English; primary grocery shopper for their household; have regular Internet access; and report that the oldest of their children between 6 and 11 years old is consuming sugar sweetened beverages at least twelve times per month or approximately three times a week Exclusion Criteria: not a primary caregiver of a child 6-to-11 years old; <18 years old; cannot read and/or speak English; not the primary grocery shopper for their household; does not have regular Internet access; and does not report that the oldest of their children between 6 and 11 years old is consuming sugar sweetened beverages at least twelve times per month or approximately three times a week

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This randomized, controlled online study will capture beverage and snack purchases from an online store. These products will be mailed to participants for each of the 4 shopping weeks. Participants' consumption will be measured at the beginning and end of the study. As this is a within-participant study, consumption for each arm will be compared to baseline for that participant (Week 1 shopping).
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Calorie label<br>Calorie label (control) will display a calories per package label on all beverages, not just sugary drinks. This is modeled after the American Beverage Association's current Clear on Calories labels. Additionally, all snack items will have a calories per serving label. | Behavioral: Exposure to calorie information<br>* Calories for all beverages and foods<br>|
| Experimental: Sugar graphic warning label<br>All products in this arm will also have calorie labels. Beverages with added sugar will also have sugar graphic warning labels with the text: WARNING: drinking beverages with added sugars contributes to obesity, diabetes, and tooth decay along with graphics depicting the amount of sugar in the beverage. | Behavioral: Exposure to sugar-sweetened beverage warning labels<br>* Graphic images of the amount of sugar (randomly assigned teaspoons, packets, or cubes) and text warning labels<br>Behavioral: Exposure to calorie information<br>* Calories for all beverages and foods<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Beverage calories purchased, Week 1 | Logged beverage calories/100mL purchased. Number of servings per item and number of items per package varied by product; therefore, calorie amounts were standardized to calories/100mL for beverages. | one week | 
| Beverage calories purchased, Weeks 2-4 | Logged beverage calories/100mL purchased. Number of servings per item and number of items per package varied by product; therefore, calorie amounts were standardized to calories/100mL for beverages. | three weeks | 
| Beverage added sugars purchased, Week 1 | Beverage added sugars/100mL purchased. Number of servings per item and number of items per package varied by product; therefore, added sugar amounts were standardized to added sugar/100mL for beverages. | one week | 
| Beverage added sugars purchased, Weeks 2-4 | Beverage added sugars/100mL purchased. Number of servings per item and number of items per package varied by product; therefore, added sugar amounts were standardized to added sugar/100mL for beverages. | three weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent purchasing a sweetened beverage, Week 1 | Percent of parents buying a sweetened beverage within each condition | one week | 
| Percent purchasing a sweetened beverage, Weeks 2-4 | Percent of parents buying a sweetened beverage within each condition | three weeks | 
| Snack calories purchased, Week 1 | Logged snack calories/100g purchased. Number of servings per item and number of items per package varied by product; therefore, calorie amounts were standardized to calories/100g for snacks. | one week | 
| Snack calories purchased, Weeks 2-4 | Logged snack calories/100g purchased. Number of servings per item and number of items per package varied by product; therefore, calorie amounts were standardized to calories/100g for snacks. | three weeks | 
| Snack added sugars purchased, Week 1 | Snack added sugars/100g purchased. Number of servings per item and number of items per package varied by product; therefore, added sugar amounts were standardized to added sugar/100g for snacks. | one week | 
| Snack added sugars purchased, Weeks 2-4 | Snack added sugars/100g purchased. Number of servings per item and number of items per package varied by product; therefore, added sugar amounts were standardized to added sugar/100g for snacks. | three weeks | 
| Total calories purchased, Week 1 | Log of the summed beverage and snack calories purchased | one week | 
| Total calories purchased, Weeks 2-4 | Log of the summed beverage and snack calories purchased | three weeks | 
| Total added sugars purchased, Week 1 | Summed grams of beverage and snack added sugars purchased | one week | 
| Total added sugars purchased, Weeks 2-4 | Summed grams of beverage and snack added sugars purchased | three weeks | 
| Volume of sweetened beverages consumed by child, baseline | Ounces of sweetened beverages (labeled in sugar condition) consumed per day in the last month by the child as measured by the Beverage Intake Questionnaire (BEV-Q) parent self-report survey. | baseline | 
| Volume of sweetened beverages consumed by child, final | Ounces of sweetened beverages (labeled in sugar condition) consumed per day in the last month by the child as measured by the Beverage Intake Questionnaire (BEV-Q) parent self-report survey. | up to 5 weeks | 
| Volume of sweetened beverages consumed by parent, baseline | Ounces of sweetened beverages (labeled in sugar condition) consumed per day in the last month by the parent as measured by the Beverage Intake Questionnaire (BEV-Q) self-report survey. | baseline | 
| Volume of sweetened beverages consumed by parent, final | Ounces of sweetened beverages (labeled in sugar condition) consumed per day in the last month by the parent as measured by the Beverage Intake Questionnaire (BEV-Q) self-report survey. | up to 5 weeks | 
| Child enjoyment of beverages | How much do you think your child would enjoy this product? This will be answered on a 7-point likert scale. | up to 5 weeks | 
| Likely to serve or buy these beverages | How likely are you to serve or buy this product for your child in the next 4 weeks? This will be answered on a 7-point Likert scale. | up to 5 weeks | 
| Health beliefs and risk perceptions index | Summed responses to the following 7 health perception questions 6 prompted with the statement Drinking this product often would…. The statements end with the following health belief and risk perception language: lead my child to gain weight, increase my child's risk of heart disease, increase my child's risk of diabetes, make my child feel energized, help my child focus at school, and help my child live a healthy life. The other item is: How healthy do you think this product is for your child? Responses to questions about weight gain, heart disease, and diabetes will be reverse coded, so higher scores on the index will indicate a stronger positive health perception of the beverages. These will be scored on 7-point likert scales. | up to 5 weeks | 
| Estimate of how many teaspoons of added sugar are in the beverages | This variable will be measured continuously based on a text box provided to participants. Mean/median teaspoons and percentage correct responses in each condition will be assessed | up to 5 weeks | 
| Perceived amount of added sugar in beverages | This variable will be measured on a 3-point Likert scale ranging from too little for my child to too much for my child. | up to 5 weeks | 
| Noticing the label | Participants will respond yes, no, or I don't know to the item: When you selected a beverage to purchase in the store, did you notice any labels on the beverages other than calorie information? | up to 5 weeks | 
| Perceived label influence | Participants will respond: yes, no, or I did not notice any labels in response to the question of whether the label influenced their purchase. | up to 5 weeks | 
| How much do you trust the information on this label | How much do you trust the information on this label?. Responses will be measured on a 7-point Likert scale. | up to 5 weeks | 
| Likelihood of label changing thoughts | If this government warning label were on a beverage, how much would it change your thoughts about the healthiness of that beverage for your child? This will be measured on a 5-point Likert scale. | up to 5 weeks | 
| Encourage you to give fewer beverages to your child | If you saw this government warning label on a beverage, would the label encourage you to serve your child that beverage less often? This will be measured on a 5-point Likert scale. | up to 5 weeks | 
| Negative reactions to the label | Average negative emotional response to the label will be examined (said the warning label made them feel worried, fearful, guilty, or disgusted or grossed out). Each emotion will be scored on a 5-pt likert scale with larger numbers indicating more negative reactions. | up to 5 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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food labeling, child, sugar-sweetened beverages, eating, drinking, choice behavior