Testing the Influence of Different Sugary Drink Warning Label Designs

Study Overview
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Brief Summary
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The aim of this study is to compare different sugary drink labels to see which most influence knowledge, beliefs, purchase intentions and choices. Parents of children ages 6-11 will shop in a virtual convenience store after being randomized to 1 of 4 conditions: 1) calorie labels; 2) text warning labels; 3) graphic sugar warning labels; or 4) graphic health warning. This study will provide data comparing the influence of sugary drink text warning labels and two kinds of graphic warning labels.

Official Title
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Testing the Influence of Different Sugary Drink Warning Label Designs

Conditions
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Obesity, Weight Gain, Diabetes Type 2

Intervention / Treatment
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* Behavioral: Sugary drink warning labels


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; and can read and speak English Exclusion Criteria: not a primary caregiver of a child 6-to-11 years old; <18 years old; and cannot read and/or speak English

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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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Calorie label<br>This arm will display a Calories per Bottle label on all beverages, not just sugary beverages. This label is identical to the American Beverage Association's current Clear on Calories labels (as of 2018). | Behavioral: Sugary drink warning labels<br>* This information appears in the description of the study arms.<br>|
| Experimental: Text warning label<br>This arm will display similar text proposed in a recent sugary drink warning label bill in California. Sample text: WARNING: Drinking beverages with added sugar(s) contributes to obesity, type 2 diabetes, and tooth decay. The calorie label will also appear on all beverages. | Behavioral: Sugary drink warning labels<br>* This information appears in the description of the study arms.<br>|
| Experimental: Sugar graphic warning label<br>This arm will graphically display the amount of sugar in each sugary beverage along with the same text used in the text warning label arm. The calorie label will also appear on all beverages. | Behavioral: Sugary drink warning labels<br>* This information appears in the description of the study arms.<br>|
| Experimental: Health graphic warning label<br>This arm will graphically display potential negative health effects of over consuming sugary drinks for each sugary beverage, along with the same text used in the text warning label arm. The calorie label will also appear on all beverages. | Behavioral: Sugary drink warning labels<br>* This information appears in the description of the study arms.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hypothetical beverage choice | Participants will select a beverage to purchase in the virtual store. Our outcome will be the percentage of parents choosing a 20-ounce sugary drink for their child | The survey will take up to 20 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Likely to serve or buy these beverages: | Item: 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. | The survey will take up to 20 minutes | 
| Parent feels good serving the beverages | Item: Serving this product to my child would make me feel like I am doing something good for my child. This will be measured on a 7-point likert scale. | The survey will take up to 20 minutes | 
| Child enjoyment of beverages | Item: How much do you think your child would enjoy this product? This will be answered on a 7-point likert scale. | The survey will take up to 20 minutes | 
| Health beliefs and risk perceptions index | We will create this outcome by summing 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. | The survey will take up to 20 minutes | 
| 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. | The survey will take up to 20 minutes | 
| 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. | The survey will take up to 20 minutes | 
| Noticing the label | Participants will respond yes, no, or I don't know to the item: When you selected a beverage to buy for your child at the beginning of this survey, did you notice any labels on the beverages other than calorie information? | The survey will take up to 20 minutes | 
| 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. | The survey will take up to 20 minutes | 
| Favor or oppose sugary drink warning label policy | We will compare the percentage of participants in favor of (combining somewhat favor and strongly favor), opposed to (combining somewhat oppose and strongly oppose), or neutral about the policy based on the following question: Would you favor or oppose a government policy requiring a warning label to be placed on beverages with added sugars? Ratings will be from -2 to 2. | The survey will take up to 20 minutes | 
| Likelihood of label changing thoughts | Item: 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. | The survey will take up to 20 minutes | 
| Encourage you to give fewer beverages to your child | Item: If you saw this government warning label on a beverage, would the label encourage you to serve your child that beverage less often? The responses will be measured on a 5-point Likert scale. | The survey will take up to 20 minutes | 
| How much do you trust the information on this label | Item: How much do you trust the information on this label?. Responses will be measured on a 7-point Likert scale. | The survey will take up to 20 minutes | 
| Negative reactions to the label | We will examine the average negative emotional response to the label (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. | The survey will take up to 20 minutes |