The Influence of Sugar-Sweetened Beverage Warnings: A Randomized Trial of Adolescents' Choices and Beliefs.

INTRODUCTION

California, New York, and the cities of San Francisco and Baltimore have introduced bills requiring health-related warning labels for sugar-sweetened beverages. This study measures the extent to which these warning labels influence adolescents' beliefs and hypothetical choices.

DESIGN

Participants completed an online survey in which they chose a beverage in a hypothetical vending machine task, rated perceptions of different beverages, and indicated interest in coupons for beverages. Data were collected and analyzed in 2015.

SETTING/PARTICIPANTS: A total of 2,202 demographically diverse adolescents aged 12-18 years completed the online survey.

INTERVENTION

Participants were randomly assigned to one of six conditions: (1) no warning label; (2) calorie label; (3-6) one of four text versions of a warning label (e.g.

, SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay).

MAIN OUTCOME MEASURES

Hypothetical choices, perceptions of beverages, interest in coupons, and endorsement of warning label policies were assessed.

RESULTS

Controlling for frequency of beverage purchases, significantly fewer adolescents chose a sugar-sweetened beverage in three of the four warning label conditions (65%, 63%, and 61%) than in the no label (77%) condition. Adolescents in the four warning label conditions chose fewer sugar-sweetened beverage coupons and believed that sugar-sweetened beverages were less likely to help them lead a healthy life and had more added sugar compared with the no label condition.

CONCLUSIONS

Health-related warning labels on sugar-sweetened beverages improved adolescents' recognition of the sugar content of such beverages and reduced hypothetical choices to buy sugar-sweetened beverages.