Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
Appetite. 2020 Feb 1;145:104484. doi: 10.1016/j.appet.2019.104484. Epub 2019 Oct 15.
Sugar-sweetened beverages (SSBs) are one of the largest added sugar sources to diets in the UK and USA. Health warning labels reduce hypothetical selection of SSBs in online studies but uncertainty surrounds their impact on selection of drinks for consumption. Calorie information labels are also promising but their impact on SSB selection is unclear. This laboratory study assessed the impact on SSB selection of 'on-pack' labels placed directly on physical products: i.a pictorial health warning label depicting an adverse health consequence of excess sugar consumption; and ii.calorie information labels. Potential moderation of any effects by socio-economic position (SEP) was also examined. Participants - 401 adults, resident in England, approximately half of whom were of lower SEP and half of higher SEP, were asked to select a drink from a range of two non-SSBs and four SSBs (subsequent to completing a separate study assessing the effects of food availability on snack selection). The drinks included 'on-pack' labels according to randomisation: Group 1: pictorial health warning label on SSBs; Group 2: calorie information label on all drinks; Group 3: no additional label. The primary outcome was the proportion of participants selecting an SSB. Compared to not having additional labels (39%), neither the pictorial health warning label (40%) nor calorie information labels (43%) affected the proportion of participants selecting an SSB. Lower SEP participants (45%) were more likely to select an SSB compared to those of higher SEP (35%), but SEP did not moderate the impact of labels on drink selection. In conclusion, pictorial health warning labels may be less effective in reducing SSB selection in lab-based compared with online settings, or depending on label design and placement. Findings suggest that effects might be absent when choosing from real products with actual 'on-pack' labels, positioned in a 'realistic' manner. Field studies are needed to further assess the impact of 'on-pack' SSB warning labels in real-world settings to rule out the possible contribution of study design factors.
含糖饮料（SSB）是英国和美国饮食中添加糖的最大来源之一。健康警示标签减少了在线研究中对 SSB 的假设选择，但对其对消费饮料选择的影响仍存在不确定性。卡路里信息标签也很有前景，但它们对 SSB 选择的影响尚不清楚。本实验室研究评估了直接放在实物产品上的“包装上”标签对 SSB 选择的影响：i. 描绘过量糖摄入对健康不良后果的图片健康警示标签；ii. 卡路里信息标签。还研究了社会经济地位（SEP）对任何影响的潜在调节作用。参与者 - 401 名居住在英格兰的成年人，其中大约一半来自较低的 SEP，一半来自较高的 SEP，要求他们从一系列两种非 SSB 和四种 SSB 中选择一种饮料（在完成一项单独的研究评估食物供应对零食选择的影响之后）。根据随机分组，饮料包括“包装上”标签：第 1 组：SSB 上的图片健康警示标签；第 2 组：所有饮料上的卡路里信息标签；第 3 组：没有附加标签。主要结果是参与者选择 SSB 的比例。与没有额外标签（39%）相比，图片健康警示标签（40%）和卡路里信息标签（43%）都没有影响参与者选择 SSB 的比例。与高 SEP 参与者（35%）相比，低 SEP 参与者（45%）更有可能选择 SSB，但 SEP 并没有调节标签对饮料选择的影响。总之，与在线环境相比，图片健康警示标签在减少基于实验室的 SSB 选择方面可能效果不佳，或者取决于标签设计和放置方式。研究结果表明，当从具有实际“包装上”标签且以“现实”方式定位的真实产品中进行选择时，可能不存在效果。需要进行实地研究来进一步评估现实环境中 SSB 警告标签的影响，以排除研究设计因素的可能贡献。
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