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Sugar-Sweetened Beverage Health Warnings and Purchases: A Randomized Controlled Trial.

ABSTRACT: INTRODUCTION:Five U.S. states have proposed policies to require health warnings on sugar-sweetened beverages, but warnings' effects on actual purchase behavior remain uncertain. This study evaluated the impact of sugar-sweetened beverage health warnings on sugar-sweetened beverage purchases. STUDY DESIGN:Participants completed one study visit to a life-sized replica of a convenience store in North Carolina. Participants chose six items (two beverages, two foods, and two household products). One item was randomly selected for them to purchase and take home. Participants also completed a questionnaire. Researchers collected data in 2018 and conducted analyses in 2019. SETTING/PARTICIPANTS:Participants were a demographically diverse convenience sample of 400 adult sugar-sweetened beverage consumers (usual consumption ?12 ounces/week). INTERVENTION:Research staff randomly assigned participants to a health warning arm (sugar-sweetened beverages in the store displayed a front-of-package health warning) or a control arm (sugar-sweetened beverages displayed a control label). MAIN OUTCOME MEASURES:The primary trial outcome was sugar-sweetened beverage calories purchased. Secondary outcomes included reactions to trial labels (e.g., negative emotions) and sugar-sweetened beverage perceptions and attitudes (e.g., healthfulness). RESULTS:All 400 participants completed the trial and were included in analyses. Health warning arm participants were less likely to be Hispanic and to have overweight/obesity than control arm participants. In intent-to-treat analyses adjusting for Hispanic ethnicity and overweight/obesity, health warnings led to lower sugar-sweetened beverage purchases (adjusted difference, -31.4 calories; 95% CI= -57.9, -5.0). Unadjusted analyses yielded similar results (difference, -32.9 calories; 95% CI= -58.9, -7.0). Compared with the control label, sugar-sweetened beverage health warnings also led to higher intentions to limit sugar-sweetened beverage consumption and elicited more attention, negative emotions, thinking about the harms of sugar-sweetened beverage consumption, and anticipated social interactions. Trial arms did not differ on perceptions of sugar-sweetened beverages' added sugar content, healthfulness, appeal/coolness, or disease risk. CONCLUSIONS:Brief exposure to health warnings reduced sugar-sweetened beverage purchases in this naturalistic RCT. Sugar-sweetened beverage health warning policies could discourage sugar-sweetened beverage consumption. TRIAL REGISTRATION:This study is registered at www.clinicaltrials.gov NCT03511937.

SUBMITTER: Grummon AH

PROVIDER: S-EPMC6803129 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Sugar-Sweetened Beverage Health Warnings and Purchases: A Randomized Controlled Trial.

Grummon Anna H AH Taillie Lindsey S LS Golden Shelley D SD Hall Marissa G MG Ranney Leah M LM Brewer Noel T NT

American journal of preventive medicine 20191002 5

<h4>Introduction</h4>Five U.S. states have proposed policies to require health warnings on sugar-sweetened beverages, but warnings' effects on actual purchase behavior remain uncertain. This study evaluated the impact of sugar-sweetened beverage health warnings on sugar-sweetened beverage purchases.<h4>Study design</h4>Participants completed one study visit to a life-sized replica of a convenience store in North Carolina. Participants chose six items (two beverages, two foods, and two household ...[more]

PMID: 31586510

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Project description:IntroductionU.S. policy actions focus on reducing sugar-sweetened beverage purchases. Yet, there are no studies on trends in overall purchase distribution and how it has changed by key subpopulations. This study examined changes in distributions of total sugar-sweetened beverage purchases and its major subtypes (regular carbonated soft drinks and fruit/sports/energy drinks) in 2002-2014 and distinguished among low, moderate, and high purchasers.MethodsLongitudinal data on sugar-sweetened beverage purchases of U.S. households from the 2002-2014 Nielsen Homescan Panel were used. Sugar-sweetened beverages were defined as all caloric non-alcoholic beverages containing added sugars. Longitudinal quantile regression model examined trends across distributions (from quantile 25 to 95) of purchases (measured in kcal/day/capita), while accounting for households' unobserved differences. All statistical analyses were conducted in 2019.ResultsAll households across the total purchase distribution significantly reduced their purchases. High purchasers made less proportional reductions than low purchasers (e.g., 35% at 95th quantile vs 62% at 25th quantile). However, the smaller relative reductions among higher purchasers translated into larger absolute decreases (e.g., 134 kcal/day/capita at 95th quantile vs 23 kcal/day/capita at 25th quantile). Similar patterns in heterogeneity were observed across sugar-sweetened beverage subtype distributions and among racial/ethnic and income groups. In addition, there were significant racial/ethnic and income disparities in total sugar-sweetened beverage purchases in 2002-2003. Although racial/ethnic disparities among higher purchasers improved, income disparity patterns at all purchase levels persisted into 2013-2014.ConclusionsFrom 2002‒2003 to 2013-2014, U.S. households at all purchase levels made meaningful reductions in sugar-sweetened beverage purchases in both absolute and relative terms. Furthermore, racial/ethnic disparities in total sugar-sweetened beverage purchases narrowed, but income disparity patterns persisted.

Project description:Background: Current obesity theories suggest that the repeated intake of highly palatable high-sugar foods causes adaptions in the striatum, parietal lobe, and prefrontal and visual cortices in the brain that may serve to perpetuate consumption in a feed-forward manner. However, the data for humans are cross-sectional and observational, leaving little ability to determine the temporal precedence of repeated consumption on brain response.Objective: We tested the impact of regular sugar-sweetened beverage intake on brain and behavioral responses to beverage stimuli.Design: We performed an experiment with 20 healthy-weight individuals who were randomly assigned to consume 1 of 2 sugar-sweetened beverages daily for 21 d, underwent 2 functional MRI sessions, and completed behavioral and explicit hedonic assessments.Results: Consistent with preclinical experiments, daily beverage consumption resulted in decreases in dorsal striatal response during receipt of the consumed beverage (r = -0.46) and decreased ventromedial prefrontal response during logo-elicited anticipation (r = -0.44). This decrease in the prefrontal response correlated with increases in behavioral disinhibition toward the logo of the consumed beverage (r = 0.54; P = 0.02). Daily beverage consumption also increased precuneus response to both juice logos compared with a tasteless control (r = 0.45), suggesting a more generalized effect toward beverage cues. Last, the repeated consumption of 1 beverage resulted in an explicit hedonic devaluation of a similar nonconsumed beverage (P < 0.001).Conclusions: Analogous to previous reports, these initial results provide convergent data for a role of regular sugar-sweetened beverage intake in altering neurobehavioral responses to the regularly consumed beverage that may also extend to other beverage stimuli. Future research is required to provide evidence of replication in a larger sample and to establish whether the neurobehavioral adaptations observed herein are specific to high-sugar and/or nonnutritive-sweetened beverages or more generally related to the repeated consumption of any type of food. This trial was registered at clinicaltrials.gov as NCT02624206.

Project description:Background: The reduction of sugar-sweetened beverage (SSB) intake may be beneficial for weight management and other related health conditions; however, to our knowledge, no data exist regarding the spontaneous changes in other dietary components or the overall dietary quality after an SSB-reduction intervention.Objectives: We explored longitudinal changes within and between an SSB-reduction intervention (SIPsmartER) and a physical activity intervention (MoveMore) with respect to spontaneous changes in 1) energy intake and macronutrients and micronutrients, 2) dietary quality [Healthy Eating Index-2010 (HEI)], and 3) beverage categories.Design: Participants were enrolled in a 6-mo, community-based behavioral trial and randomly assigned into either the SIPsmartER (n = 149) intervention group or the MoveMore (n = 143) matched-contact comparison group. Dietary intake was assessed through a mean of three 24-h dietary recalls at baseline and 6 mo. Dietary recalls were analyzed with the use of nutritional analysis software. A multilevel, mixed-effects linear regression with intention-to-treat analyses is presented.Results: SIPsmartER participants showed a significant reduction in total SSBs (mean decrease: -366 mL; P ? 0.001). Several spontaneous changes occurred within the SIPsmartER group and, compared with the MoveMore group, included significant HEI improvements for empty calorie, total vegetable, and total HEI scores (mean increases: 2.6, 0.3, and 2.6, respectively; all P ? 0.01). Additional positive changes were shown, including significant decreases in total energy intake, trans fat, added sugars, and total beverage energy (all P ? 0.05). Few dietary changes were noted in the MoveMore group over the 6-mo intervention.Conclusions: Intervention of the single dietary component SSB resulted in additional spontaneous and beneficial dietary changes. Interventions that target a single dietary change, such as limiting SSB intake to <240 mL/d (<8 fl oz/d), may improve the overall dietary quality health and provide motivation to make additional dietary changes. This trial was registered at clinicaltrials.gov as NCT02193009.

Project description:BackgroundFew longitudinal studies examine the response to beverage taxes, especially among regular sugar-sweetened beverage (SSB) consumers.ObjectiveThis study aimed to examine changes in objectively measured beverage purchases associated with the Philadelphia beverage tax on sugar-sweetened and artificially sweetened beverages.MethodsA longitudinal quasi-experiment was conducted with adult sugar-sweetened beverage (SSB) consumers in Philadelphia (n = 306) and Baltimore (n = 297; a nontaxed comparison city). From 2016 to 2017 participants submitted all food and beverage receipts during a 2-wk period at: baseline (pretax) and 3, 6, and 12 mo posttax (91.0% retention; data analyzed in 2019). Linear mixed effects models were used to assess the difference-in-differences in total purchased ounces (fl oz) of taxed beverages in a 2-wk period in Philadelphia compared with Baltimore. Secondary analyses: 1) excluded weeks that contained major holidays at baseline and 12 mo (42% of measured weeks at baseline and 12 mo) because policy implementation timing necessitated data collection during holidays when SSB demand may be more inelastic, and 2) aggregated posttax time points to address serial correlation and low power.ResultsThere were no statistically significant changes in purchased ounces of taxed beverages in Philadelphia compared with Baltimore in the primary analysis. After excluding holiday purchasing, the tax was associated with statistically significant reductions of taxed beverage purchases at 3 and 6 mo (-157.1 ounces, 95% CI: -310.1, -4.1 and -175.1 ounces, 95% CI: -328.0, -22.3, respectively) but not 12 mo. Analyses aggregating all 6 wk of posttax time points showed statistically significant reductions (-203.7 ounces, 95% CI: -399.6, -7.8).ConclusionsA sweetened beverage tax was not associated with reduced taxed beverage purchases among SSB consumers 12 mo posttax in the full sample. Both secondary analyses excluding holiday purchasing or aggregating posttax time periods found reductions in taxed beverage purchases ranging from -4.9 to -12.5 ounces per day. Larger longitudinal studies are needed to further understand tax effects.

Dataset Information

Sugar-Sweetened Beverage Health Warnings and Purchases: A Randomized Controlled Trial.

Publications

Sugar-Sweetened Beverage Health Warnings and Purchases: A Randomized Controlled Trial.

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