Impact of Front-of-package Warning Labels on Perceived Weight Stigmatization

Study Overview
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Brief Summary
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The goal of this experiment is to examine the effects of three different types of front-of-package warning labels for sugar-sweetened beverages on perceived weight stigmatization, as well as the effect of making such labels more weight-neutral. The main questions this experiment aims to answer are: Are certain types of front-of-package warning labels perceived as more stigmatizing than others? Are more weight-neutral versions of front-of-package warning labels perceived as less stigmatizing than their regular versions? Is there a trade-off between label effectiveness in discouraging product consumption and perceived weight stigmatization? Additionally, this experiment also aims to answer the following questions: Does exposure to certain types of front-of-package warning labels lead to changes in participants' weight bias? Are changes in participants' weight bias as a result of label exposure mediated by attribution of personal responsibility for body weight, pathogen disgust, or perceived social consensus?

Detailed Description
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Participants will be randomly assigned to see one of four types of labels: control labels, nutrient warning labels, text-only health warning labels, or graphic health warning labels. Participants will then see an image depicting different types of fictional sugar-sweetened beverages carrying the label type that they were assigned to. Participants will see this image twice, in random order, each time differing in whether the label is weight-neutral or not (i.e., whether the label references calories/obesity or not). Each time, participants will answer survey questions about the label. Last, participants will answer survey questions measuring their weight bias and potential mediating variables.

Official Title
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Examining the Impact of Different Types of Front-of-package Warning Labels for Sugar-sweetened Beverages on Perceived Weight Stigmatization Among a Sample of US Adults

Conditions
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Weight Stigma

Intervention / Treatment
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* Behavioral: Nutrient warning labels
* Behavioral: Text-only health warning labels
* Behavioral: Graphic health warning labels
* Behavioral: Control labels


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: At least 21 years of age. Residing in the US. Exclusion Criteria: -Involved in any pre-testing.

Ages Eligible for Study
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Minimum Age: 21 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: Factorial Assignment
Interventional Model Description: Between-subjects intervention: label type (4 arms); Within-subjects intervention: regular or weight-neutral version of label (2 versions).
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sham Comparator: Control labels<br>Individuals in this trial arm will see neutral control labels on sugar-sweetened beverages. | Behavioral: Control labels<br>* In random order, participants in this arm will see an image of fictional sugar-sweetened beverages carrying: A neutral bar code label A neutral quick response (QR) code label (not scannable)<br>|
| Experimental: Nutrient warning labels<br>Individuals in this trial arm will see nutrient warning labels on sugar-sweetened beverages. | Behavioral: Nutrient warning labels<br>* In random order, participants in this arm will see an image of fictional sugar-sweetened beverages carrying: Labels that read high in sugars and high in calories A label that reads high in sugars<br>|
| Experimental: Text-only health warning labels<br>Individuals in this trial arm will see text-only health warning labels on sugar-sweetened beverages. | Behavioral: Text-only health warning labels<br>* In random order, participants in this arm will see an image of fictional sugar-sweetened beverages carrying: A label that reads Drinking beverages with added sugars contributes to obesity, type 2 diabetes and tooth decay A label that reads Drinking beverages with added sugars contributes type 2 diabetes and tooth decay<br>|
| Experimental: Graphic warning labels<br>Individuals in this trial arm will see graphic health warning labels on sugar-sweetened beverages. | Behavioral: Graphic health warning labels<br>* In random order, participants in this arm will see an image of fictional sugar-sweetened beverages carrying: A label that reads Drinking beverages with added sugars contributes to obesity, type 2 diabetes and tooth decay and contains graphics illustrating obesity, type 2 diabetes, and tooth decay A label that reads Drinking beverages with added sugars contributes type 2 diabetes and tooth decay and contains graphics illustrating type 2 diabetes and tooth decay<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perceived weight stigmatization, mean score | Stigmatization of people with obesity will be measured by survey through a three-item scale. Items will inquire about how much participants perceive the label to (1) stigmatize people with obesity, (2) promote negative stereotypes about people with obesity, and (3) portray people with obesity in a disrespectful manner. Response options will be on a 1 to 5 scale, with higher scores representing a higher perceived weight stigmatization by the study labels. Each participant's responses to each item will be combined to obtain their final score on the outcome. | Immediately after exposure to intervention (i.e., study stimuli), assessed during one-time online study survey. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perceived message effectiveness, mean score | How much the labels discourage participants from wanting to consume the products will be measured by survey. Response options will be on a 1 to 5 scale, with higher scores representing a higher perceived message effectiveness. | Immediately after exposure to intervention (i.e., study stimuli), assessed during one-time online study survey. | 
| Weight bias, mean score | Weight bias will be measured by survey through a seven-item scale. Items will present participants with adjective pairs and ask that they select the box closest to the adjective that they feel best describe their feelings and beliefs about people with obesity: (1) lazy-industrious, (2) no will power - has will power, (3) good self-control - poor self-control, (4) active - inactive, (5) self-indulgent - self-sacrificing, (6) dislikes food - likes food, (7) undereats - overeats. Response options will be 5 boxes between adjectives, which will be coded on a 1 to 5 scale so that higher scores represent higher weight bias. Each participant's responses to each item will be combined to obtain their final score on the outcome. | Immediately after exposure to intervention (i.e., study stimuli), assessed during one-time online study survey. |